10828_General Permit_19920715

CAMA AND DREDGE AND FILL
GENERAL•
r' � �•
PERMITS 1�
as authorized by the State of North Carolina C__M ,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7// ') G ''
r Applicant Name
Address 94 '
Phone Number G Y 3- 7�a aZ
City State
Project Location (County, State Road, Water Body, etc.) �/' u�� E� `�'�6 �� �� ��' 7
Type of Project Activity _L"`-tv..f �^-� �. edJt c.�ol� / % <- ) 3 7—
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PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
C
cubic yards
Boat ramp dimensions
O�ber
SKETCH e Lv r0 7-1�
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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.
To• / /�
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(SCALE: '+I i
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applicant's signature
permit officer's signature
issuing date expiration date
attachments � -" /"' � — � b I -,-? �') I)
In issuing this permit the State of North Carolina certifies thatO/� C�l l3 13
this project is consistent with the North Carolina Coastal applicationLi /�
Management Program.

or
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that•I own property adjacent to
's property
ame
located at (e UYl 46VJI,yf MQOXicf 141JO on
(Lot, Block, Road, etc.)
I �•� in A)ncy /31F2w1 Ceyui'J , 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 I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
sY-1:F A)ewll�I��
County of
nature
State of
Name
Notary Public Phone Number
My Commission Expires:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
ereby certify t at I own property adjacent to
1./ 9 - ' s property
_ Name
located at ��G /d�gatic 'Wae'''ir ,C,cc on
Imo, (Lot, Block, Road, etc.)
1 , Jfr�t ink,#,Q ZEOu CAA N.C.
(Water Body) (Town and/or County)
He has described to me as shown below the development he is
proposing at that location andpi 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)
06LUr )U
-,
County
State o
Notary Public
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Signature
Ps \-'� . C1��s ri v
Name
( :�, 3
Phone Number
My Commission Expires:

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