10814_General Permit_19920623

CAMA AND DREDGE AND FILL WA
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GENERAL PT
�0) PERMIT V N� 10814
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 15 NCAC r1 /y — /oz )
Applicant Name !, ✓F',1 [<�
Address fL f
City. on r
Project Location (County Road, Water- B
[/A A i - -,C — Z Gti
Type of Project Acfjvity
Phone Number
State
etc 1 C it L
Zip 7h�S
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PROJECT DESCRIPTION
Pier (dock) length
SKETCH
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(SCALE:
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Groin length.
number
Bulkhead length
max. distance offshore
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 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.
applicant's signature
�j Jr ermit fficer's signature
issuing date expiration date
attachments _ # // Q
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee _ d 4-Q - v

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify thatI own property adjacent to
�(e ��V} ( / r �. , �_ �, ,f_- Is property
Name
located at ��� % � ! ;.1,.1 on
(Lot, Block, Road, etc.)
in ���, �r�. ,�;y , 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 fifteen feet (151) from my area of riparian access
unless waived by me.
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)
t
Name
Phone Number