23527_BERNHOLZ, MARTIN_19991124 (2)

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CAMA and DREDGE AND FILL <d/
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G E N-E R A L (I 23527
PERM I'T
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 % i-t 1- t f
Applicant Name h Phone Number
Address
City C ti �' ( l I i 7 / r� . State f Zip 9
Project Location (County, State Road, Water Body, etc.) C
Type of Project Activity / ice• I ��" �> ' fit. 7! :' <. r-'�L- r �. l l_ ; % !.,
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This permit is subject to compliance with this application, site drawing �,�-.. �•�,�
and attached general and specific conditions. Any violation of these terms applicant's signature
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- permit officer's signature
ficer when the project is inspected for compliance. The applicant certi- 9 v '/ r /,
fies by signing this permit that 1) this project is consistent with the local issuing date expiration date
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. y{ attachments
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program. application fee

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AIVAOR A PjeR1,CENT IIWARLALN pRopjEyry OUInM
(FV0,qFj2VG PJU T
A NGS1 B0 A2ZJM7 ATI�W� B0 OU THS.E)
hereby aert'ry that I OWn property dj,,,,, to
Age,', Alm
(Name Of Pr
WDWY I=tW at opertjr Owmer) a1 y�+' Otp Block, Road, etc.) 153
Y.
yvalerbody) 7-
f
County N.C.
(TO���&Dr
He has describej
location, me, a-, shoNvn below
dOn, and
the dev +11i
have na objecdorls to )1,3 proposal,
is Proposing at that Of se must be nt back a understand that a pie
rPa-riu f1ccus urdess waived "illf"I'm distxn� of fif�,, f r/znoo&g -
by me. t (15) from my
I Abiat wish to waive dhe seth.,-I,
A
4, AQ wish to wn;,,
2L Setback requirement.
(TTed '0ESCRn3'n00NbAjtPND/0It DRA %Mr' OF PROPO in ED DEVZWp
S
by W[Yid4dPMMtT)7Z MLW.,
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Atllovr-rypc
Nam e
Telej One Number
Date.
A..
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ADJACENT RIPARIAN pROMTY OWNER STAT043W,r
(FOR A PIER/MOORIIVG prUNGSIBOA7UPT/BGL4TX0USIskj
I hereby certify that I awn pOp-fty adjamt to AR'TiN
A44N41 ��11i �GZ►s
(Naoat of Property Owner}
Property located at 54(.0
Block, Road, etc.)
an
in C-4je'r"p-
(Watertdy) {Torre and/or County) N.C.
- He has described_ to me,, s -shown below,•-fhr dcy
location, and, I have, no cobjections to his cUnd1>atenr he ia�roposisig at -that
Pgoatift/boaouse must be set back 8 minimum distance of stand that a pier/moo�8
of riparian access unless waived by me. fifteen feet (15,) from my area
I o 00 wish to waive the setback u
� +ement.
I wish to waive that setback requirement.
DESCRIPTION AND, 'OR DRAWING OF PR ~
(To be,idled in b • PRO. DE�'EL()PM i'T:
Y (ndmdua! prnposfn'► development]
Signature -
Print or Type N me
�9_- �g��
Telepl,,one Number
Date:
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08/12/00 SAT 14:18 FAX
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