10892_General Permit_19920916

CAMA AND DREDGE AND FILL .�
GENERAL
PERMIT N9p 10892
as authorized by the State of North Carolina (-Ol
Department of Environment, Health, and Natural Resources and the Coastal rces Commission
in an area of environmental concern pursuant to 15 NCAC 7 H / ;� r' <'
Applicant Name I& Phone Number a
Address a S p h-, /)/�
City > / < State !�• r Zip 7
Project (location (Co ntyr VState Rpa^Bd, Water dy, etc.) S _5
Type of Proi ct Activity
PROJECT DESCRIPTION
SKETCH r f 17A
/J (SCALE:
�
Pier (dock) length
F,
Groin length
number
T�
e
Bulkhead length
` a
y
P !�
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
O er tyi%
L
%u
G
v,
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 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 statemer: has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
applicant's signature
permit officer's signature
issuing date expiration date -
attachments
In issuing this permit the State of North Carolina certifies that h , o
�r
this project is consistent with the North Carolina Coastal application fee ��� �G (�
Management Program.

19
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
pe4 ye_ /l ' s property
Name J
located at !�% — �7 ITLC���e�C j �7 on
`(Lot, Block, Road, etc.) � ca 1U U in A, V� T Y" , N.C.
(Water Body) (Tow and/or County)
He has described to me as shown below the development he is
proposing at Z-1lat location and I gave no objections to his
proposal. I understand that a pie;- must be set back a minimum
distance of fifteen feet (151) 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)
ayo o37y
Signure _
,Name
Phone Number

l�
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
A ! /? /i i- o , , , , - i7
Name
's property
located at ,Cf _ )� ���� �. ��/f6 �2� �' on
C (Lot, Block, lRoad, etc.)
inR\���2�y� �Q . ���� 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' ) fro,n 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)
Sign;aEure
Name
Phone Number

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