10891_General Permit_19920914

ApplicantNme
Address �
City . z�
CAMA AND DREDGE AND FILL
GENERAL
PERMIT PTO o
,� p 1 891
as authorized by the State of North Carolina C
Department of Environment, Health, and Natural Resources and the Coastal Re urces Commission
in an area of environmental concern pursuant to 15 NCAC 7 1 q I i G' 0
Y Phone Number 2 / 97 Y 76 — S//5' k_,
n x. V / CJ
Project�ocation (County, State Road,
.4 ti
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length.
number
Bulkhead length
max. distance offshore
-9`
Basin, channel dimensions
cubic yards
Boat ramp dimensions
O her __..
State y` C
Rudy, etc)
zip
SKETCH �' �, %—� (SCALE: )
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This permit is subject to compliance with this application, site / I ,
drawing and attached general and specific conditions. Any j/� •x._
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. �1
This permit must be on the project site and accessible to the (/ permit officer's signature
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.
issuing date
attachments /� G A -
In issuing this permit the State of North Carolina certifies that '1y'
this project is consistent with the North Carolina Coastal application fee��
Management Program.
expiration date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own prop "ty adjaceent to s
prope y located at-
c (lot, block, road, et .
on in v�'^� , 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.
LId do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
A)&
-4t A Signature
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to
property located at 4 / -� Ul
(lot, block, road, etc.) �/
/�a� �i c�+1 w+ in zd � Z" 061
on �K1t' / ULda., N.C.
(water body) IV (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 do not wish to waive that setback requirement.
(�.Ml one
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
IL
u 1 y
ignature
Name
,;2 Z17" �2d�
Phone Number

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