10793_General Permit_19920617

CAMA AND DREDGE AND FILL
GENERAL
PERMIT &_tlo� - N° 10793
as authorized by the State of North Carolina A',"�� 4 C w
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7h 1900
Applicant Name
Address a
City _ 1�
Pr(, - t�Loca ' ( untState Road, Water Body, etc.)
/7
Type of Project Activity
PROJECT DESCRIPTION I SKETCH 19TA
Pier (dick) length ¢
Groin length
number
Bulkhead length
max. dist�>e offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
This permit is subject to compliance with this application, sire
drawing and attached general and specific conditions. A y
violation of these terms may subject the permittee to a fin ,
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.
Phone Number 633 S 0 7
State C ip S S
)v
/J r!
O VQ 611
(SCALE
i
applicant's signature
permit orricer's s
6`17`7;l.- %-17--%;
�j issuing date] expiration date
attachments ' CA C / � /� D
o o c
application fee d 4 7
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
I

ADJACENT RIPARIAN- PROPERTY CANER STATEMENT
(FOR A PIER) 4,
I hereby certify that x own p4.overty•adjacent to
1)(2, imAx
's property located at
(Name of Prope ty Owner)
(Lot, Block, Road, etc.) '
an 'in Qovfib1. N.C.
(Waterbody) (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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be. fired in by ir.jividual proposing development)
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Print or Type Name
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER sTATEMENT
(FOR A PIER)
I hereby certify that I own property. adjacent to
's property located at
...AName of Pr/ope ty Owner)
Q/L���
(Lot, Block, Road, /etc. )
on I J I �, F� , 'in /i%uJ �S h� �/,-��i� N.C.
�
(Waterbody). (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.
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DESCRIPTION AA'D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f i 1? ed in by S.__nl i vidual proposing de veloprgent )
• I� - J�[Gr Imo'
Print or Type Name
t�i 11)- (0 yli
Telephone Number

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