10894_Margaret Terry_19920918

CAMA AND DREDGE AND FILL
CENE?AL
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Y� R
`
PERMIT r � �•
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
6
Applicant Name Phone Number 3 SAS
' Address S I 7��
City.,/� e� State Zip
Project Location (Count , State Road. Water Body, etc.)
of P�ojecf,
q­ /LI _,f, T —U a'� e ' i x i�eI, " /-!i
PROJECT DESCRIPTION SKETCH &k/ f/l}
G (,t",-
Pier (dock) length
Groin length;
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Othera
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ly'Zxll'w
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
(SCALE;
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applicant's signature
permit officer's signature
issuing date -- _Expiration date
attachments
application fee ;k S'dr (? t) ca' I / t / / �Z

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to Mllkelqr-F-7- 1 . 762:iF-' 1 's
property located at
(lot, block, road, etc.)
onJJBl:E C'�iz�K- in CFF�FT-F7— , 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 15 feet from my area of riparian access unless waived by me.
do not wish to waive that setback requirement.
circle one)
Description and/or drawing of proposed development: (to
,bbet�filled in by individual
proposing development)
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7ignature
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent ton:aigG�'g� `- TE?4ef ,s
property located at
(lot, block, road, etc.)
on LJJ9J?=E C-Z6679 in CT lf�-c , 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 15 feet from my area of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
e one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development) Q e
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c
oo
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Signature
\� 11 mac. �p•r+. C-
Name
Phone Number

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