10779_General Permit_19920519

s
" i * CAMA AND DREDGE AND FILL
GENERAL — C
PERMIT 0 10779
as authorized by the State of North Carolina
Cop
Department of Environment, Health, and Natural Resources and the Coastal Resources Commi�sion
in an area of environmental concern pursuant to 15 NCAC %iV //00 1 /30 4d
Applicant Name cF'"'^ �'t' /� Phone Number
Address /V y D X
City, State �� zip :2 9
Project Location (County, State Koad, ater,�°dy, etc.)
Typ of Project A tivit
PROJECT DESCRIPTION SKETCH c� Q(SCALE:
Pier (dock) length At -Ail
Groin length, C�
number
Bulkhead length ' \
d ao
ax. distancy offshore ,j
Basin, channel dimensions D-O o C% d a C) 0 O a o
/�, 6"'O4J0 Q 0 °Odd �v
cubic yards ^ D
Boat ramp dimensi ns
p' X /D r
Other
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- t applicant's signature
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.
issuing date
permit officer's signature
-/ 5 — q,?
expiration date
attachments
In issuing this permit the State of North Carolina certifies thatl O (�O/' 3
this project is consistent with the North Carolina Coastal application fee go 1`� % ,FZ
Management Program.
.ri

ADJACENT RIPARIAN PROPERTY OWWM STATEMENT
(FOR A PIER)
I hereby certify that I own property.adjacent to
M '
(Name of Property Owner) s Property located at
14M Afj sd4.
(Lot, B16ck, Road, etc.) '
on IJE OS IZ ttti , in N 6v jGEVu Cn&Ufib , N.C.
(W'aterbody). (Town and/or County)
Fie 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
Y
unless waived b 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:
(Tv be f; lied it by 5..^.dividual proposing development)
x;s w y N kud A. ;JO&
JI
P9
County of ✓ �/
Slate of �� �,� /�nM Signature I
Print or Type Name
o Telephone Number
PJptary -Public
My Commission Expires g.9.92

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property. adjacent to
(Name of Pro s Property located at
Property Owner)
Ti :uFiu view 14m 1,T -r a.
(Lot, Bl6ck, Road, etc.)
on �EuS17 , in AJ&v GZA . N.C.
(Waterbody) (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.
�. I do wish to waive that setback requirement.
--•---------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f i lied ir. by ind i-vidual proposing development)
- K:S ► w y N Rod f
J
6PJ� Its,
P9 )D�-
County of
State of
Notary Public
14y Commission f<xpires 6-9-92
Signature
Print or Type Name
Telephone Number

�,-i7-9 -�
/L,t� /Y e�

41
K!lm