26608_CIZERLE, FRANK_20000914 (2)

CAMA and DREDGE AND FILL 266118 :
G E N E R A L;
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
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 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
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

Gpp`d &4")e 6112
1�RANKLIN J. CIZER1,V
303 RIVER IWACI I COl1H'1' ss-74s7/z560
SWANS130RO, NC 2&584-8480 DATE)
PAY TO THE •^ r
ORDER OF 1J C /t' $
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NAVY
FEDERAL
CREDIT UNION
V I ENNA. VIM GINI 1 /
FOR L� Y (� y (iJ 97 400s6 h£?-'1 / %
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I hereby certify tWt I own property adJacelt fi �� � -A
(Name of l ,ro"v 0":Mcar)
(mot, fflo�, Road,
on 1d#1
(Town anWor C ry
�% has de.�c;n�. A w ine, as shown below, the devctop�j;�„xt tot ,s pz�owsing at that
loci n, id, I hays �, :� � carts to his propowl. I undernmW j;Cp.t a' 'ecf'rlcov
must be set bark a �����r: ,��n dia�ce of fifteen fact IS from m arwa � errd beat iift
waived by me. ( �} y °��� a,�ess runless
dQ PA M.!41 to waive the setback requirement.
IJ9 WA 4c WPive that setback requirement.
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&"/OR 11RAW ING OF PROPOSE
cd in by muUndual proposing dsysk,p;.;�;.:�►;b
Woob DOCK
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Print or TMe Name
J�-) 7H 1
Telephone NunlbSti' - — -

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ADJACENT R)T'" tk-9 ,�YPe► Ty 0'4-,VT,�Z S" i'A►TEA O ANT
l hereby cxmfy t1 :t I own propoty Adjacrrtt
(Name of hip-40brtv~G.vner)
property located at U j UFff
jgL/L a vv s
("t, .Block, Road, )
v
,,
(Watry-bc;dyi (Town and/or Y) .� �� N. '.
- .He h:LS dcutilt-A �ja Brae, as ,hown below, the devclopn-k,_,t.,, ;s ryropasin that
e
locati t I have -c :aty,�,�cns to his propowl. I understand L�At a psexjwiwverzd bow lift
waivedd by me, mast set bask � "�z��a1: ��n d;a�ce Of fifteen feet (15') frOn! my UM 4Oparlan acres imless
I SQ old Wish TO waive the setback requirement.
149 W14 #c W:4ve that setback requirement.
D]P CR T, e .:; x x; < AWND/OR DRAWING OF PROPOSEYi �; ¢' v , ."
he ,mod in by in&idual purposing develog, p)
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I�.o ooD DOCK
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Signature - -
Print or Type Name
Telephone Number
Date:

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