24448_WHITE, PHILIP_20000126

0
CAMA and DREDGE
G E N E
PERM
as authorized by the State o
Department of Environmen
in an area of environmental
Applicant Name
Address
t
�'V
AND FILL •
R A L�
V
I T
f North Carolina
and Natural Resources and the Coastal Resources Commission
concern pursuant to 15 NCAC
City
Project Location (County, State Road, Water Body, etc.)
Phone Number _
State Zip
- ,Lj.
Type of Project Activity I I �1-
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.
�. ?C-,1)
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
� �-- ,.. N •; Y iv�.� ,? " '. tic.: .
application fee

--�---�---..�..� y'.. .....-._......,.,,�uww�V

ADJACENT RIPARIAN PROPERTY OWNER STA
(FORA rrEv
I hereby certify that I own
property adjacent to � ► L l
s
ame of Amperty Owner)
property locates at 2-)a5��p,laS C Y� IV,— -
�^^'' (Lot, Block, Road, etc.)
on i ,95 C�� t- -A 2� : 7
ody) in -� l .Atu l C� C N.C.
(Town lamp ,
He ham' � me, as shown below,
location; and, I have no objt develog�m� h
must be -set back a rflinimum
waived by me.
—. I dQ- 49t wish to
I Jq wash to
to his propo undmu,,j a prop sing at that
e of fi S l tb ' a P1er/uncovered boat lift
\ (1J �) fMM my "rTio rip,, o�-- s iiiti
the
that setback
regUu=enL
DE.SC')ri s --_ -
AND/OR DRAWING OF mopom;► DL, v pMENT:
(To be filled W by ilz&w luol RIPPOS"g d a :ek e-,)
4-
Litt �}
5:- IS,
PYint or Type Name
T_Cv31 42� elephone Numb��r"'
Date: 0�

�'A~a
ADJACENT RIPARIAN PROPERTY OWNER STA
TIIINT
(FOR A rl
'I,
I hereby certify that I own property adjacent to /" pe�y Own4Vter) is
- , (Name o� Pro
Property locates at 35"� e,Er4k D s c �e
(Lot, Block, Road, etc.)
on
in
�dy (Town ass' T
�®may)
Heh'�� df Ltd to me, as shown below, the deye opm�� he is
location; and, _I.have ago objections to his F1Op°�g at that
must be set bank a Tidrimum distance of fifteen feet (15) from t a Pita' uncovered boat lift
waived by me. y aytia Of riparian access unless
IILQ,4 t wish to waive the setback raquiremenL
I.09 wish to waive that setback TequiremepQ,
DESG -I, .__.. - __ - -_
AND/OR
Ari DRA►�'t MG OF PROPQ��:h�+ DL,,V . LUpMENT:
(To be filled in by indz Diu& prOFOss.>ag "�r�����?�
Signature
Print or Type Name
�z sz) z L? q3-5
Telephone Number
Date: