13913_JACOBS, HENRY_19920214

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT V\\_
,^ as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name Phone Number
Address
City.
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State Zip
PROJECT
Pier (dock) length
V
Groin le
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number
length
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max. distance offshorei�■
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MIFF
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any j
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.
-r
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 _
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.
applicant's signature
permit officer's signature
issuing date �—— expiration date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that -I own property adjacent to
Horn m . ,T,,,-n Gs Is property
Name
located at aQZ.0 r J on
(Lot, Block, Road, etc.)
u E in /V E'o 17£/24, C 'e4 u ,&r') N. C.
(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 fif teen feet (15') from my area of riparian access
unless waived by -me.
I do not wish to waive that setback reauirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (To BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPNfNT)
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13 e �8T Noo J fz
W i 016
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Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that.1 own property adjacent to
H RRy m . GJ ' s property.
Name
located at 5-3 I
(Lot, Block, Road, etc.)
�11ZF4TJ }R, -u F-x in
(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.
V I d• 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)
i
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.41
�2 —�- 3 0
o w 13A Signature
Name
Phone Number
on