25668_ALLEN, MIKE; ROBBIE WEBB_20000621

CAMA and DREDGE AND FILL$_. j
G E N E R A L
�ow
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project 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.
Phone Number
zip
issuing date
applicant's signature
permit officer's signature
expiration date
attachments
application fee

THIS M�Ig"'S
I Eli PRE
II' S 4 780 7 ?u, i:0 S 3 LO L L 2 0: LO L 908000 Lill
Ti4iE QRd:GIN.'AL�DOCAN1ENTiFIAT�FAiREFLEC�iTiINiE; WA'TiERMARK OIV HE'9A,CI�IiOLDTArTiTA�N/ANLE�fiiC1 ViA 1��NtHENI�NE'f�G�tTiFI�ENRSiT,:�

IMPORTANT MESSAGE
FOR
DATE
d� TIMES=—P
NA
OF q
t 0
PHONE
AREA CODE
NUMBER EXTENSION
❑ FAX-
�MOBILE
AREA CODE
NUMB R TIME TO CALL
PLEASE CALL
TELEPHONED
CAME TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
RUSH
RETURNED YOUR CALL SPECIAL ATTENTION
MESSAGE I
1 �� 1,�� ,o'er
/J16 rrrQL�S "TT
SIGNED
FORM
002
IN AS
M

ADJACENT RIPARIAN PROPERTY OWNER STATF TEEN-r
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby cer-dfy that I own property adjacent to IqLL15N 's
(dame of Property Owner)
property located at ( ;� 1 J- s E Ma L 4M F MLK
(Lot, Block, Road, etc.)
on M tP m40F CAP—(, in J�f l L"T7 C 73C !- 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 obj�--tions to his proposal. I understand that a pier/uncovered boat lift
must be set back a minimum distance of rifte°n fit (1.5') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
t'Z I do wish to waive that setback requirement.
----------------------------------------- - --- - ---------------- - ------------------- --- — -- ------------- ---- -
DESCRIPTION A-N-D/OR DRANVriG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
M,"U �e ��i IK� oQoS 9
? rb
t i E�
I � 7t �
f L
1®
1
y
----- ------------------------------- ------------------------ --- --- ------------------------ ----------
nature
�-7
77
Prim— ype Name
_2 7-4.5
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to K aL. -rp Is
(dame of Property Owner)
property located aj'ZI Poe7m S' PF M r L. M ()-Ar— C ,
(Lot, Block, Road, etc.)
on MAO M A E CAPAL in )q-IrUAi i'(c_ rR C 14
(iWaterbody) (Town and/or County)
He has described to me, as shown below, the deve!opment he is proposing at that
locadon, and, I have no objections to his proposal. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (I5') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
✓ I do wish to waive that setback reouirement.
DESCRIPTION' .A-ND/OR DRAwNPiG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
s r 1P (C. Qo Q°SAD T-
t tad}?t of r-
i H 6 ,
tD& �eR )NC.
i
--__-_-- -----------------_-- ____-p I-K----
Signature
FD rCnn��1 �o
Print or Type Name
7210 -- 5-6 � /
Telephone Number
Date: 6 117 L o 0

ONA I L16 b AI zLi5 tJ
DTLJD' Ss , c
�LR N� P�. (-. a7s-'��