23569_SULLIVAN, JIM_19991021

4 1
CAMA and DREDGE AND FILL
Applicant Name
Address
City
G E N E R A L ( 23569 - C
P E R M I T T>,) �ALt - L
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 C5*-.3 +cx��c�lft t(ca�/c t
Phone Number! "'�z�
State Zip
Project Location (County, State Road, Water Body, etc.) A 7
Type of Project Activity PL -1:,C-k_ [LINul V!_ r"i - au.x- -e,, i'Flt
t./Jk-M A 1tT. ti (L,- 7 , , � 1 , -',,i I r't.jiGO11
PROJECT DESCRIPTION SKETCH ( 'EC r tI> Eli (SCALE:
Pier (dock) Length T i ILIFFF
--
Groin Length �^ - k- -�
number - 31 7� i
Bulkhead Length
max. distance offshore4_ +
141 1 1 1 f if
? I i'
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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
permit officer's signature
issuing date expiration date
)' 1 attachments
YD
application fee

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
I-(1/VW 's property located at r7n
,�` lot, block, road, etc.
f3Aon N �US� J`( ��� in _ n -/7- L C G � CD Uhl �Y , N.C.
(body of water) (town and/or county)
The proposal has been described to me as shown below: the development, a
pier/ ulkhea / structure, and the proposed location, and I have no objections
(circ e one)
to the proposal. I understand that if the development is a pier, it must be
set back a minimum distance of 15 feet from my area of riparian access unless
waived by me. I do/ do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: ( to be filled in by
individual proposing development.)
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(Original must be retained in the Inspection Department)
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S' ature
Name (Please Print)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J/ M
7"0GL[V60,j 's property located at �n M�J�krS6,J
`' ((�� �`` lot, block, road, etc.
on !v 6US� 9( 01E% in nP"60 L(GG CD o-'J 7-y- N.C.
(body of water) (town and/or county)
The proposal has been described to me as shown below: the development, a
ier/ bulkhea / structure, and the proposed location, and I have no objections
(circ a one)
to the proposal. I understand that if the development is a pier, it must be
set back a minimum distance of 15 feet from my area of riparian access unless
waived by me. I do/ do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: ( to be filled in by
individual proposing development.)
ll]C�AT���C J4 �C�T�JG i./CTT�JC�TJ{�J{lC J4 TI�J��TT�]4 A�4T�i�]�TJCII JC T I{JIJC �JG �JC �{JCA����X�{�TJCT ��G TIIT Ti`Ji ��f JC �C
(Original must be retained in the Inspection Department)
ignature
Name (Please Print)