10866_General Permit_19920819

O
CAMA AND DREDGE AND FILL <=b
GENERAL
�M
PERMIT N9 10866
as authorized by the State of North Carolina 6
Department of Environment, Health, and Natural Resources and the Coastal Resources Co sion
in an area of environmental concern pursuant to 15 NCAC �/ //0 �'
Applicant Name _(! �na2 / �!C_J�Uecr114- Phone Number l h
Address . 00
City
Project Location (Cou
State Road, Water Body, e
�o(_�q k /1—� c
__e . •
State /C--C
F T //
r /%/-Q� i%
zip
Type of Project Activity 'r '
PROJECT DESCRIPTION SKETCH ,�A (SCALE:
Pier (dock) length
Groin length,
number
Bulkhead length
ma,x. distance offshore D _ N
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 applicant's signature
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
permit officer's signature
issuing date expiration date
attachments :�C C �// 1106
c' y
application fee / � � �C) (/ # 71

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
II hereby� � certify that -I own property adjacent to
u cQ h o vK Is property
ame
located at ('0 0 2211C
(Lot;
T I
, Road, etc.
. on
(!R fi RIC in Al&t) EfR,& 0,1290 6,) , 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 (15') 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)
County of
State of
Notary Public
N�
�-CC
Signature
Name
633 - -5-�c32.
Phone Number
My Commission Expires:

,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
Ihereby certify that•i own property adjacent to
Ih
— )IJ el 's property
ame
located at % oos, 8l�,',
C? ,
, on
(Lot, Biocx, r(oaa, eLc.)
in /VF 13FOw. („�� , N.C.
(Water Body) (Town nd/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 (15') 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)
County of
State of
Notarv/Pub,iis
My Commisplion Expires:
NAW AW 4
SFFC r
Signature
Name
Phone Number