24597_DEBUTT, DICK_20000424

CAMA and DREDGE AND FILL
,.� G E N E R A L 24597
PER M I T
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
QI I QLLCIf-I It:-U rt::[ MI Qi Qf I l If t- i.in RL U V 1 IJ. / %11 Y V IVI au V l IV I II ICDC 1CI 11 IJ
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 permitthe 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

ADJACENT RIJPARLA►N PROPERTY OWNER STAT .+J
(FOR A PIERIA100RLVG PILINGSIMATLIF` IBOATHOI�'SE)
I hereby certify that I own property adjacent to CL !�Zo 's
1 (Name of Property Owner)
property located at c9c� j-12 ADD COO2-}-
(Lot, Bloell Road, etc.) 1 `9 I c4 `V
on
(Waterbody)
M
(Town and/or County)
N.C.
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 pierimooring
pilings/boatlilt/boathouse must be set back a minimum distance of fifteen feet (15') from my area
Of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCREMON AND/OR DRAWING OF PROPOSED DEVELOPMEENT:
(To be filled in by individual proposing development)
APR 12 2000
/�;. � � /-Z'
Print or Type ame
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATUVIENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent tob bc—�I�Z�t is 's
(Name of Property Owner)
����-�- ����1 ►� C__. �'pW
property located at
(Lot, Block, Road,,"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. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Old
D
APR 12 2000
COASTAL MANAGEMENT
Signature
Print or Type Kame
Telephone Number
Date: A