28040_LEWIS, BERRY_20010626

i/
AM C A and DREDGE AND FILL
G E N E R A L =&t"
PERM I T f
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name ,
Address
City
Project Location (County, State Road, Water Body, etc.)_
Type of Project Activity t
Phone Number
State zip _
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
(SCALE:
�m
Groin Length
..
number '
i
Bulkhead Length
V.
max. distance offshore
m
Basin, channel dimensions
cubic yards
s
Boat ramp dimensions
Other
I
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emnce�am
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_.e�.>,wAwe++ex»s
tn.>oms.: •••. ><r' •: .:^>.m> sA v<...a...�.. 9s�•a e:;::,,,..--->or.. ..r,w,m
This permit is subject to compliance with this application, site drawing
and attached general and specific conditions. Any violation of these terms
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they
have no objections to the proposed work.
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
• applicant's signature
I permit officer's signature
issuing date expiration date
attachments
application fee

y OSPREY
MARINE CONSTRUCTION
Docks • Seawalls • Osprey Nest • Boat Lifts
919-728-4980
Marine Repairs ROGER CONNER

BEmr K. LEWIS 4734
PH. 242-4064 NCDL 1606897
P.O. BOX 272,205 POPE ST. - -
PIKEVILLE, NC 2780 mate ss-I 1053I
70503
62)
M L n %h '% I A I U
BB&T IIIII�
BRANCH BANKING AND TRUST COMPANY
�PIKEVILLE, NORTH CAROLINA \� y O
,:053 LO L L 2 P: 10530657631" 473
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ADJACWr RIPARIAN PROPERTY OWNER gr TEMENr
(FOB A PlBR M00J iNG P)UNGS/BOA TUlPT I ®a _ ®b L
that I �m propctty adjacent to Y T !- t*s i S
I hereby certify (N or Pt perty Owner)
111.'p
an
in ('.qa _ ---V I.C.
(W'aterbody) (Town and/or Couoty)
He hu describod to acre, as dwwn below, the developrrrcrt he is proposing at that
location, and, I have no dblections to his proposal. I understand that a pier/mooring
pig must be set back a minimum distance of MUM feet (15') from my area
of riparian access ualw waived by me.
I djj& aritih to wove the setback requirement.
I do wish to waive that setback requim =t.
DESC IMON ANDIOR DRAWING OF PROPOSED DEWEI�OPMEKT:
(To be JUW is by ,Lr&yMud pmpos&g developne*) rs�
Ito.. U ,�,�,�r�p ,� ► �-------- , r--.°`'a
,4
C-
--_�------------- _�-_______-------------------
at�
19� Signature
s '
Print or Type Name
C-)
Telephone Number /
Date: 3 , 0 1

ADJACFNr
R 'ARIAN pRopEjtTY OWNER $TATFIAMM'?
(FOR A PIEWMOOlUNPILIIVOSIBOA DTI O T �,US) b�
I hereby certify that I own proIXM adjwent to 2Ll
1 of Aro perty
(w, 1
in , N.C.
on _
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is ProPoent at that
location, and, I have no objestioas to bis proposal. I understand that a pier/moonnt
pit must be set bank a minimum distance of fifteen fat 051) front my a"
of riparian assess ual ess waived by me,
I #ALJA wish to waive the setback requirement.
I wish to waive that setback requirement.
_ _--- --------- -----------PMF1°iT. ---
DnCRIPTION ANDIOR DRAWING OF pROFOSED DEVUD
(To Pw in by IX&PUNWPMpodag developa:sart) N
f �
I-
---- -W----- _---------
Sitnatu
Viirt or Name
Telephone Number
Date: L -2-o�-_V

• MM'
LOCATION:
MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
' S NAME: C�(V a'IPERMIT #
�Q. / FIELD REP.
PHONE: R
��� DATE � REPORTEDLY COMPLETE: Q
1) Do th sured dimensions of the development differ from those indicated in the permit and workplat?
YES O [circle one] .
COMMENT:
2) SEDIMENTATION E OSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized
all disturbed areas? t�"
[circle one]
COMMENT:
3)
action needed?
COMMENT:
[circle one].
Is further investigation or enforcement