10921_General Permit_19920922

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Applicant Name
Address
City
CAMA AND DREDGE AND FILL
GENERAL
PERMIT ZONT
as authorized by the State of North Carolina F)A14
Department of Environment, Health, and Natural Resources andes r ission
in an area of environmental concern pursuant to t5 NCAC /
l/ Phone Numb?/er
Projec`t-E`iScation Y ty, ate
Type of Proj ceActivity
Water Body,,etc�
PROJECT DESCRIPTION I SKETCH /,4E7- �C6/
Pier (dock) length
Groin length
number
Bulkhead length
ax. distance offshore /
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
71
/ `'roo
This permit is subject to compliance with this application, site ,
drawing and attached general and specific conditions. Any �C
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. i
This permit must be on the project site and accessible to-a.l=_.
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
0is consistent with the local land use plan and all local
ances, and 2) a-w__RReff-3t T&e eht has been" U'Mimst-f om
giatent riparian lad ers ying' that 'they fiav no
'k 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.
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applicant's signature
�- permit icer's signature
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issuing date expiration date
.-/attachments
6•-
application fee

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'0 GENERAL PERHIT APPLICATION INFORMATION
0
APPLI CANT' S NAME:
(First) (Middle) (Last)
x JPM
ADDRESS:
v% STATE ZIP lf:J2,9
TELEPHONE: WORK ( ) HOME
CONTRACTOR'S NAME: "`(�' � � �/%/ �� ��� TELEPHONE NUMBER
PROJECT LOCATION: N.C. Hwy. # SR # Road/Street Name B
Waterway Name & e- 4z S _ County C
Town B cam'` Subdivision
PROJECT ACTIVITIES:
PIER: Total dimensions of pier from MHW to platform
(Length) (Width)
'T' or 'L'-head platform
(Length) (Width) (Number of Mooring Piles)
Water depth at end of pier
OVOUSE/BOAT LIFT:
Length
Number of Piles
BULKHEAD: 411 Total length P�o r7`
F
Average distance waterward MHW
Number of Mooring piles
Width
Water Depth
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Maximum distance waterward MHW 1,6 -- ot %mil` t
#2 Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY'] -
Length
Width
Base width from MHW
Depth of Cut
Adjusted water depth on MLW Existing water depth(s)
Estimated Cubic Yards (length x width x depth/27)
Type of spoil: Sand Mud
( •Dragline
OTHER STRUCTURES:
Backhoe
Hydraulic

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ADJACENT RIPARIAN PROPERTY
I ereby ce=that-I own property adjacent to
's property
Name
located at 3J�� �V i�_ v on
(Lot, Block, Road, etc.)
y
.n. Q-fmv ink/�,.� �J N.C.
(Water Body) wn 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.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELO )
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Name 1
Phone Number
i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that -I own property adjacent to
4 Cv ( /// -e
's property
Mme U
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located at 1 k ��� on
(Lot, Block, Road, etc.) `//
in GN.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_japdar-&tand
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVBI.O
Name
Phone Number