23270_CANNON, BILL_19990924

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CAMA AND DREDGE AND FILL ceq °
GENERAL N,2 23270_ c
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name` Phone Number
Address
City i .`•.Yt lCVjL-L State Zip -
Project Location (County, State Road, Water Body, etc.) IF
Type of ProjectAc ti. ? ?�°Y' llfil'•�r?�� 1;,
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PROJECT DESCRIPTION I SKETCH (SCALE:
Pier (dock) length - F-
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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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 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.
tJ�a-
applicant's signature
permit officer's signature
issuing date expiration date
attachments C1 `
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
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application fee
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ADJACENT RIPARIAN PROPERTY OWNER STAMI EENL T
I hereby cP�-tify that I own property adjacent to L S T y P. is
(NME, of Property Owner)
property Iocated
(Lot, BIock, Road, a c.)
lve4v't LC,tOe
(`vVa:ter'hody) (Town and/or
He has dear°ribed to me as shown below, the development he is 1)-Li •posing at that location,
and, I .have tto .:actions to his proposal.
-10N AND/OR DRAWING OF PT�C�;,,.,,; ;?F:
.�OP'tiMIN-T
Po be filled in by individizal proposiri, de %.,,.-._�
Signature
i-1.
Print or Type Name
z s�. 632 -qVI
Telephone Numbe:
Date: 3 .Sego '/sY p