10789_General Permit_19920611

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�.. R CAMA AND DREDGE AND FILL
r GENERAL
PERMIT Na 10789
as authorized by the State of North Carolina
k, Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
l in an area of environmental concern pursuant to 15 NCAC -7 H / IOC 1`- ( v Oe)
G Applicant ame �o, Phone Number
Address Y O
City
Proiect L cati
n
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length /f LX y
Groin length
number
Bulk h ad length
� 8 Ig
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
o
State /� r • Zip a
n (County State Rn;id WItIr Bod etc) 9 l � � -° %.�� l R,
Y,
SKETCH ;� �f(I
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 projeict-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.
(SCALE:
applicant's signature
b�A
permit officer's signature
6—//- Ion 9-1, - '/)_
issuing date expiration date
attachments
application fee

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to
--.4—
Name
's property located at
Owner)
, Block, Road, etc.
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r
on P A A I W_--4a'A"ZAr- N . C .
(Waterbo y) (fown and/ r 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. All' Cr
------------------5-' -----�"-'----------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Print or Type Name
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Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Owner)( -Name ofPz�rf�
's property located at
U " 'CJ (Lot, Block, Road, etc.)
(Water -body) If WTown and/c County)
He has described to me, as shown below, the development he is
proposing at that location, an , I have no objections to his
proposal. IT
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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A L- IJ /'IV _ n- l? A 2 1L (? tL T k
Print or Type/Namee
Telephone Number

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