23513_COOPER, BUD_19991007

0CAMA and DREDGE AND FILL Cdl
,.� G E N E R A L N'r13-
� �
PERMIT C 13..0 .
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 119v Phone Number 5
Address 1 f c
City lF ` r % State Zip �- t
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
Pier (dock) Length
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

ii'10025521AIPI i:0531076331:016260 9980020

ADJACENT RIPARIAN PROPERTY OWNER STATF
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to (M co 0 Pi54- is
(dame of Property Owner)
property located at L
(Lot, Block, Road, etc.)
on 00r GANflL , in �!4}W7C-
(Waterbody) N.C.
(Try and/or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncovered boat,lift
must be set back a minimum distance of rirteen fit (115') from my area of riparian access unless
waived by me.
do not wish to waive the setback recuirement.
I do wish to waive that setback requirement.
DESCR=O.-LND/OR DR NIVD G OF PROPOSED DE`-ELOP-NMN'T:
(To be j"Med in by individual proposing development)
c�-
P CT 0 5 1999
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541 6 � w /L L OAS MoREHEA01 M
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Signature
GZZ�4 SLO46 Print or Type Name
�a6 ,a66S
Telephone Number
Date:

ADJACENT REPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFE
I hereby certify that I own property adjacent to Bal) C( C,6 n�- 's
(dame of Property Owner)
property located at LET -so I
(Lot, Block, Road, etc.)
(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 objetitions to his proposal. I understand that a pier/uncovered boat lift
must be set back a minimum distance of ritteen fit (I5') from my area of riparian ac=s unless
waived by me.
t I do not wish to waive the setback requirement.
I do wish to waive that setback recuirement.
DESCRIPTION N-D/OR DRAwZVG OF PROPOSED DEVELOP_'1MN-T:
(To be filled iiz by individual proposing development)
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6t Pam&
SLiq�
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ian e
Print or Type Name
T19 ' r-63'�1
Telephone Number
Date:
OCT 0 5 1999

ss� � 9141-71
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