25694_QUIRIN, BRETT; BOBBY BRIGHT_20000705

CAMA and DREDGE AND FILL 4`5
G E N E R A L
PERMIT
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 (Count)4 State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
State
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.
Phone Number
zip
(SCALE: )
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

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JUN-26-u0 MON 06.43 AM ALAMANCE INDUSTRIAL PARK FAX,336 226 3535 PAGE 2
.rL� 22 '00 11:17RM BBB OFFICE PRODUCTS
UED
pIVISION OF COASTAL MANAGEMENT
ADJACENT' RIPARIAN PROPERTY OWNER NOTMCATIONlWATVIER FORM
Z
Name of Individual applying for Permit:---- 4 -
Address of Psbperty:
(Lot or Street+, Street or R026, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, HeAmn Pima 11,151-8, Hwy, 24, Morehead City, NC, 28557 or doll (252) 848-
280 within 14 days of receipt of thi's nodes -No response is considered ills same as no objection
if you have been notified by Certified Mail.
- WAIVER SECTION
boat house, lift or sandbags must be
understand that a pier, dock, mooring pilings, breakwater,
set back a.minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waivc the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 S' setback requirement. e
I do not wish to waive the 15' setback requirem
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Signature Date
,,. au
Print Name
Te phon Number With ea C de

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for R Permit:- �; � ��
, ^ten
Property:
Address of ProP e
-
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plaza II, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbaes must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
�/� x I do not wish to waive the 15' setback requirement.
Sien�#ure Date
Print Name
Telephone Number With Area Code

Precision and Productivity withou Co promise.
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