25601_DAVIS, DEAN; CURT GILLIKIN_20000519

CAMA and DREDGE AND FILLi1t-�
G E N E RA L X
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's Phone Number
Address
city State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity .k
PROJECT DESCRIPTION SKETCH
Pier (dock) Length
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(SCALE:
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Groin Length
number
Bulkhead Length/
max. distance offshoreFH-
L
1
or
Basin, channel dimensions
cubic yards (
Boat ramp dimensions
m
m
Other
/
..... .........
aL
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.
i1+ '
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to AC-4� arA.� Is
(Name of Property Owner)
property located at
(Lot, Block, Mai; etc.)
on , in ��� , N. C.
(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 objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
- 2& 2'�'/
Signature
Print or Type Name
Telephone Number
Date: La �'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to o&", t -1 's
(Name of Property Owner)
property located at
(L6t, Block, Road, etc.)
on , in (�� , N.C.
(Wate body (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Signature
T) ") fw -, d
rint or, Type Name
Telephone Number