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G E N E - R A— so-)01-3A 28254-
PERM IT
as authorized by the State of North Carolina
)110 ... Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 1 K . '‘�,'_) 3 c4 ! .:1 1 I3- /
Applicant Name J hi')'( li ck N S Phone Number -;J 7- i?6, q
Address ` 6 5' /�t. ' / ‘41.4
City /4-174»,)/s” ') State NC Zip .a i ti t/3
Project Location (County, State Road, Water Body, etc.) ci,, 1 ?"2 UA`)L' `f _ S vt f-k C-el '(
,r)M,'-f U w (4 A II ri l.fit W I, ` P4vvi (J.4" l_f A.o
Type of Project Activity ..,.\K IA `2-1? 1A.,kve ) Dr- £)e, S'f�fLD S'i fit/c_1`Lot "Le
PROJECT DESCRIPTION SKETCH (SCALE: / r= of C' )
Pier(dock)Length _ 3
in
..„
Groin Length .
number IN
I al
— — t .__
Bulkhead Length
max.distance offshore II I 1
Basin,channel dimensions
I M.
cubic yards
Boat ramp dimensions
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lUflhlli
Other --
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This permit is subject to compliance with this application, site drawing —,,,. L����.
and attached general and specific conditions.Any violation of these terms applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void. 4
This permit must be on the project site and accessible to the permit of- permit officer's signature
ficer when the project is inspected for compliance. The applicant certi- 0 I C/ -0 1 / - t S- o I
Pies by signing this permit that 1)this project is consistent with the local issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has _
been obtained from adjacent riparian landowners certifying that they ? 1< . 0� 0 3
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project $ 0 U. C) ('Kj: - 4 "--
is consistent with the North Carolina Coastal Management Program. application fee
•
CODES FOR AEC DESIGNATIONS
"OH" - Ocean Hazard "PT" - Public Trust
"EW" - Estuarine Waters "CW"- Coastal Wetlands
"ES" - Estuarine Shoreline "FC" - Fragile Coastal Natural/Cultural
"PW" - Public Water Supply "OR" - Outstanding Resource Water --
CODES FOR PROJECT
"P"- Private-usually an individual "F" - Federal
"C"- Commercial "L" - Local Government
"U" - • Utility "H"- Housing Development
"S"- State : "0" - Other
# CODES FOR PROJ DESCRIPTION
"11"- Bulkheads,Riprap "16" - Utility Lines •
"12" - Piers,Docks Boathouses "I7" - Emergency Repairs
"13" - Boat Ramps "18" - Beach Bulldozing
"14" - Wooden Groins "19" - Temporary Structures
. "15" - Maintenance of Basins, Channels,Ditches _GENE L PERMIT COMPUTER FORM
APPLICANT NAME: 7J0\0b1 C N S -
ADDITIONAL NAMES: Stor•At Cart,K S
AEC DESIG: G W t P 1- 1 E.-5 DEVELOP AREA:_a0 3.- PROJ DESC:r
, (Will only take 6)
(Will only take 1)
WORK: 6 - 93
(Will only take 4)
MAINT:
(Will only take 4)
Gqg
(will only take )
ACTION EXPIRATION
DREDGE&_FILL REQUIRED: - 0 ?. - ( f vU I I U / 1 l
CAMA MAJOR DEVEL REQUIRED:
q,vg / 7 V
DIVISION OF COAST&L &N&GEMEN'T
tad&FENT RIP ARI&N PROPERTY OWR`ER NOTiF C&TION1WkiVE FORM
Name Of Individual Applying For Permit 34�C� 1e CZ d--5
Address Of Property: 9e,?a. Ag,e4429Lcf/..t-ci
Sv,',c et 7Z/ 47C-. � ' f` Okisio w
(Lot or Street i, Street or Road, City & County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
'Z I have no objections to this proposal.
If' vow have objection to what is being prnpn et1 pl ace write. the 1>Mcir n of Costal
Manaaern•nt 177 North Cardinal Drive Wilmi�°� North Carolina nR40S or cal] 910 i4
"9DD within 10 days of receipt of This notice No grspo Ise is considered the tame as no objection
ifyoun have bin notified by C'errified Mail
W AINTR SECTION
I nnrl-rstand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbars must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you mist initial the appropriate blank below.)
X 12.64. I do wish to waive the 15' setback requirement_
I do of wish to waive the 15' setback requirement.
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Signature 1'
dip/vie, .8._dzcxpy
Print Name NCDENR
Telephone Number With Area Code ham,.,CAROu u Dt n,�rr of
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. DIVISION OF roAST&L MAN&GEMENT •
ArgarrNT RTP ART etN PROPERTY OWNER NOTIFICi&TION/WAIWR FORM
Name Of Individual Ai•ping For Perak go by El e ea r
Address Of Property: 2.2- 1ro cA)
f C Act zqccasidtA)
(Lot or Street if, Street or Road, City&County)-
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying,for this permit has described tenfie as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
have no objections to this proposal.
‘._
If ynn have objections to what is _being proposed please write the llivisinn of Coastal
. .
1900 within JO days of Nniecpoiicei considered the_sarnensno ohjeOtinn
jf ynn have been notified by Certified Mail
WAIVER SECTION
I understand that a pier,dock,mooring piling%breakwater, boat house, lift or sandbags must be
set back a minim' um distance of 15 from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
,_,Irft I dO wish to waive the 15' setback requirement.
I do not wish to waive the LS' setback requirement
gun..
f:- ,(1lig Lop& Jr. 4.Vr
Print Name
/ 3102 t% NCDENR
Telephone Number With Area Code Nzprrre C.Artutu.DizRorerpmtcr or
ENVIR01114.- AND NATURAL RttsouRars
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DB%AntiES C- -
AC& C OOKS
Pti.(91O) S8 RVICES
Pv der of AMPS EAD 1Nc O 66-3oi 1 .
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