10777_General Permit_19920519

CAMA AND DREDGE AND FILL 9
GENERAL
PERMIT° _
as authorized by the State of North Carolina / O 7 7 7
Department of Environment, Health, and Natural Resources andlpCoastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC / 6, ' O C'
ya 1.4
Applicant Name Phone Number 6 33— ly 7 7
Address 7 30 %ZY
City
Project LoVat' n (Count, State Road, Water B
of Project Activity
PROJECT DESCRIPTION
Pier (dock) length Sd ) )e-
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
oth r
y, etc.)
SKETCH
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7
This permit is subject to co(npTiance with this app Ica ion, 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—dj6lploject 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.
State
Zip a 5;-6 b
ram, �,3a ?
(SCALE:
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applicant's signature
permit officer's signature
issuing date expiration date
attachments - /vC!* e- 7/ -/
ail
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that T own property adjacent to
��, ill 19(2 is property
Name
located at a 36 3 121,
, on
(Lot, Block, Road, etc.)
n
in / /F. Q)F,, ��O[l/w , N.C.
(Water Body) (Tow and/or County) t
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.
V 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)
sr1-7
county of
State of,�f
9 lam_
j"
Notary Public
My Commission Expires: /- /c- 5�
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Signature
Name
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I"�hereby certify that •Y own property adjacent to
✓2. M &2IC 0i E2 I B,� 's property
Name
located at a 36 3 2
on
(Lot, Block, Road, etc.)
�cQ � UJ %/j k rz i n �/F Q)F,, �° iPDr//w , N . C .
(Water Body) (Tow and/or County) t
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)
Sri
County of (�e�✓
State of
Notary Public
My Commission Expires:
�77- /),Ppw 'y
S ' nature
Name
Phone Number

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