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Applicant Name
Address
City gr
CAMA AND DREDGE AND FILL t'
016864-
GENERAL :
FEB 2 2 200'0
PERMIT f
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the C s) Res urces Commission
in an area of environmental concern pursuant to 15A NCAC �� (' ' �� �
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J,1 G. Phone Number��
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Project Lo ation (County State Road, Water Body, etc,;
` ype,f Project Activity
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PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number �t f
Bulkhead length jr
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max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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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,
applicant's signature
imprisonment or civil action; and may cause the permit to be- t f ^
come null and void.
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance._ }}
The applicant certifies by signing this permit that 1) this pro- G_ O o
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances and 2) a written statement has been obtained from %
adjacent riparian landowners certifying that they have no f'
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that 1 r
this project is consistent with the North Carolina Coastal application fee (J
Management Program.