10831_General Permit_19920728

' CAMA AND DREDGE AND FILL
GENERAL
6-zj
PERMI ti 6°f Na 10831
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the CoastalFies ces Commission
in an area of environmental concern pursuant to 15 NCAC 7 �//
Applicant Name � ? Phone Number ,
Address dd
City State ip S
Project Location ( unty State Road, Water Body, etc if s' S
Type of Project ctivity
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length 36
1( Groin length �
I
number
Bulkhead length
aj
max. distance offshore /
�- � y
Basin, channel dimensions A�
cubic yards
Boat ramp dimensions AP "e c� Sr / .�— U,,
Other i
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 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.
applicant's signature
permit officer's signature
_ak,4� ;
issuing date
attachments 4- ! 14 C 7 // / a v 0
application fee 50'
d # �'6 S
expiration date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
t�F 2Q t A- W tit—� 1 }
Name s property
located at W6 Qom.
(Lot, Block, Roa etc.) , on
in 42_—CV eQ_ — ►-� N . C .
(Water Body) own an /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 (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)
"-S C__ r-�" T T e--:4 (2_1-! ,= Q ZZ) Q.ra w z Yv C
County of
State of ----
Notary'Public
My Commission Expires:
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that•I own property adjacent to
2=<:s V-A % 's property
Name
located at 27' IE� DPI✓j-- , on
(Lot, Block Zo ad, etc.)
-T t2C rJ T 42:� V 'i = �Z in N.C.
(Water Body) ( own an /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 (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)
S E l- TT V�zt e- %-i L- � � e�z� LZ Z- Y-J
County of
State of
Notary Public
My Commission Expires:
Signature
r'�F0
Name
0.
Phone Number

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