27313D - American

•
CAMA and DREDGE AND FILL ... `�"r: 1.3 1
GENERAL
PERMIT i 0 5-22t4A
as authorized by the State of North Carolina
• Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmentaall concern pursuant to 15 NCAC 71-4 • 1500
Applicant Name P,t•- i c rA-� t',-N1,, (Urn Mont, Phone Number c110 45 1 —5488
Address t� • O . U x ��O'-(n 1
City VA-AN t State NU Zip .28L4.0I
Project Location (County, State Road, Water Body, etc.) �r u t'V`_w 1 Cr-- C O thn�vl ; Lek'Ste'
Type of Project Activity MA, n AQr(\ce_. C c dck( Y\1 c h0Ai' E q
PROJECT DESCRIPTION SKETCH (SCALE: • TO )
Pier(dock)Length 11 .��111111 Sri �gi� R 111
£
Groin Length 111
1
Lr NI II __
number _....
Bulkhead Length .1.max.distance offshore rii....
I I I I mil .:- gm!" Nig iiiisfirirn
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Basin,channel dimensions r 111
cubic ards '-
Y ., .. . :_
Boat ramp dimensions *U �I . ii . , , ..„..i
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Naga
I — .111M1 I
Other . I� .,,,I . if.. ,
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This permit is subject to compliance with this application, site drawing - / A /•, z&i
and attached general and specific conditions.Any violation of these terms J"t�'—�'� appli t' i nature
may subject the permittee to a fine, imprisonment or civil action; and .--
may cause the permit to become null and void. ..2t N(Y1
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- S :2,e, U ( t ( G
fies by signing this permit that 1)this project is consistent with the local issuing date 1 e piration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they MA • 150(.,
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project ' 1 00,
is consistent with the North Carolina Coastal Management Program. application fee

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I here y certify t t I own property adjacent to
/ Z. P / ' •
s property located at
(name),
41/4-‘40/Zi on
(lot, block, road, etc.)
4. in
(water 4bodyj'4i ,*�'f' / Old,/ ‘.2/frail Z%%'Z ig',--- , N.C.
town a 4/or county) '
He has described to as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of 15 feet from my area of riparian access unless waived
by me. I do / do not wish to waive that setback requirement. '
Description and/or drawing of proposed development:
(To be filled in by individual propoeg nt.)
7
a47 _L5*n
fataA4.4""
:\'9C=21.
(signature)
/ e-T//=``.4ise _/•
(print name)
(phone' fiC7 -757 7 ' .
number))

•
-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I here y certify t t I own property adjacent to
•
./,5Wis property located at
(name)._
on
(lot, block, road, etc. )
in
(water body)
�‘br`(7 / i/ �� , N.C.
town a 4/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 must be set back a minimum
distance of 15 feet from my area of riparian access unless waived
by me. I do / do not wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual propoei gdeve ,pment.)
U'41111•
`. C
(signature)
(print name) •
5tS7 -- 6 ?G' p
(phone number)

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1 I .
THE AMERICAN FISH CO. 66840
CHARLES H. OR KAREN Z. PERRY . 1
P.O. BOX 11046,WEST BAY ST. 66-30/53I
SOUTHPORT, NC 28461 — 2-7 *0 / 053
il DATE
it PAY
TO THE I $ 700 • 0<5
OF___DLE\A_ re_ -.
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DOLLARS
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{ Fi. FIRST CITIZENS 4" If
11 BANK PsZignIPIATc—P•"
0[' FOR nr
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