10865_General Permit_19920819

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Applicant N
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CAMA AND DREDGE AND FILL e� a
GENERALam M, -0
PERMIT 1086
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources an the Coastal R sources Com • sion
in an area of environmental concern pursuant to 15 NCAC�
Phone Number r903 n 7 /� �' lY
City w S2 /"/`-y State r T zip �i d
Project Location (County, State Road, Water Body, etc.)-t-���+
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T pe f Projec!t�ctivity T�,
PROJECT DESCRIPTION SKETCH PT"'4 (SCALE:
Pier (dock) lengthy
Groin length•
number
Bulkhead length j
max. distance offshore 1
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other G3 C
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 be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject 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.
attachments _
issuing date expiration date
In issuing this permit the State of North Carolina certifies that�O�D� �t/` /%
this project is consistent with the North Carolina Coastal application fee
Management Program.

Official Business
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Print your name, address and 2IP Code here
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tic,
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SENDER: I also wish to receive the
• Complete items 1 and/or 2 for additional services.
• Complete items 3, and 4a & b. following services (for an extra
• Print your name and address on the reverse of this form so that we can fee):
return this card to you. ``--44 yy-- r C�r �y+y�
• Attach this form to the front-,.11�UkCe,dr.,Qthe 2a%splWeal �, FI1 ] AEli' Ae's Address
does not permit.
• Write "Return Receipt Requested" on the mailpiece below the article number. 2. ❑ Restricted Delivery
• The Return Receipt Fee will provide you the signature of the person delivered
to and the date of deliverv. Consult postmaster for fee.
3. Article Addressed two:
4a. rticle Number
Yl�ld
4b. Service Type
❑ Rep' wred
ertified
❑ insured
❑ COD
❑ Express Mail
❑ Return Receipt for
5. Sig re (Addressee) 8. Addressee'i Addrdss (Only if requested
and fee is paid)
6.sin
PS r 3811, November 1990 *U.S.GPO:1991-287-066 DOMESTIC RETURN RECEIPT

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that i own property adjacent to
►EQ$c,c,� 1 J6���1 �� ftod�Grr1 's property
Name
located at )aw / , 11 G' . kl_-' .' .
_�,, on
(Lot, lock, Road,
Nf� N.C.
sElP_(Water Body) (Town and/or County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
'L I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
County of
State of
Notary Public
&it PIT 01 to i,N r
Signature
Name
L �3 - )--Z a _D—
Phone Number
My Commission Expires:

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