10776_General Permit_19920403

"LAMA AND DREDGE AND FILL
GENERAL PERMIT NW'76
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal is urces Commission
in an area of environmental concern pursuant to 15 NCAC - 1 ` f '
Applicant Name T �` C=
Address rdl t
City
Project Location (County, State Road, Water Body, etc.) —
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Phone Number
State / {Y
P i i -
Zip
(SCALE:
Pier (dock) length
Groin length
number — ---
Bulkhead length
max. distance offshore
Basin, channel dimensions i ttN
cubic yards �.�`Ir l( .�! ..� � .. _ � �,1�_,._�l---- ��✓�
Boat ramp dimensions
Other 1 /l
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 proje-ct. 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.
i✓
applicant's signature
permit officer's signature
i
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program,
application fee--:

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ADJACENT RIPARIAN PROPERTY OWNER STATEME
(FOR A PIER)
I hereby certify that I own property adjacent to
N
located at
Lot, Block, Road, etc.)
's property
, on
/Meuse eQ c`ue.r in A-11"k Ad C- 62,111ic_b �, 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 fifteen feet (15') from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
b-- I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Sign ture
fi og 14 4�
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)) fa
I hereby certify that I own property adjacent to
C1`C'4 7;/ �'�'"�l i�/l'> �; is property
e
located at XtG�%
on
,{ (Lot, Block, Road, etc.)
in �,-«�7nyl_?��,1, j�. , N.C.
(Water Body) (T 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. 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.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
W
Sign ture
Name
/- 7v�{
Phone Number