22558_CHANNEL BEND HOA_20000124

CAMA AND DREDGE AND FILL
GENERAL l t 2ppp .r8t)
PERMIT {
as authorized by the State of North Carolina CONSTMO E?"
Department of Environment, Health, and Natural Resour a Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC '
Applicant Name
Address �` ��� ` �j`✓!i'
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
Phone Number
State Zip
(SCALE:
Q.
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,
applicant's signature
imprisonment or civil action; and may cause the permit to be-
r
come null and void.
lAi
This permit must be on the project site and accessible to the
permit officer's signature
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
issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
attachments
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
application fee
Management Program.