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CAMA AND DREDGE AND FILL l9 039110 D
GENERAL
PERMIT \''.. )/'
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the fo�stal �esources CQ mission
in an area of environmental concern pursuant to 15A NCAC 1-1- 1 00 ,a- I '� �.
Applicant Name 1 1 'finP. vv 2 1) Phone Number 013) 3).ti' fi q I
Address q y q So ✓1 I
Cityc-t� S� !.A. d � Stated� c� �� ��� Zip � 'I
Project Location (County, Stale Road, Water Body,etc. ff
ddyl,tc...'C -f- VIi--`ll ih i ok. (1't(---IC , A,)Mps( e4.d , e c`er t'ovA. .I. I
Type of rojeffctActivity conSft...L, 2 oikheeel Q/1 ned. q or I�,n�y„r'�l a tS ,; uti�1, f /p 4'.
Cod)4r✓.-Y 6'X 644' pier wl4'H 7'-^eaa rt C/►44rhy 4e�.. S AriC.4.,r( I" N'a4(rw.,r c.K ,i 1i..4ti '1
51w11 nfl-I- ex Etc .1 HP� S(t.. Fa- -e- S{,.it pi-> vIJC d.c. 1n r- no Alert v.� h ti4-S.
Pi11 co.� a, ki"., s a� ?/-l. //o3 ¢ r7/!. /Az° el4-1 - tcl ) S �w/i at,
PROJECT DESCRIPTION SKETCH (SCALE: / )
Pier(dock) length hi f'/,
Y1a` 1h ru Cre k
Groin length Eli 1,
46
number et
r I
1T �vw 7..."1
Bulkhead length a' 1 !f/A(N Li.). k
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max.distance offshore
Basin,channel dimensions
cubic yards
Boat ramp dimensions -. /
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Kam. ,. , Pro e o st
cl
Other
1� 21,
0r (eSS
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any /n
violation of these terms may subject the permittee to a fine, �`p
imprisonment or civil action; and may cause the permit to be applicant's signature
come null and void. a
This permit must be on the project site and accessible to the 4, Y �j1 ���lll/// permit officer's signature
permit officer when the project is inspected for compliance- ��� O _ �� _ 0LThe applicant certifies by signing this permit that 1) this pro- ' �/
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no /7/.,/ //J 3 ..- /a 3-3
objections to the proposed work. attachments
a� Ck St /295
In issuing this permit the State of North Carolina certifies that D.
n/ n S 81(
this project is consistent with the North Carolina Coastal application fee /V k�l o
Management Program.
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• DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIYER FORM
Name Of Individual Applying For Permit: Al Rik/
Address Of Property: 3q4 BA/76n Pacplf
D
/74d5W:./(Lot or Street# oad, City & County)
I hereby certify that I own property adjacent to the above-referenced property.e The individual
P
applying for this permit has described to die as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
L I have no objections to this proposal.
If you have objections to what is being proposed please write the Division of Coastal
Management., 127North Cardinal Drive, Wilmington North Carolina, 28405 or call 910 395-
3900 within 10 days of receipt of this notice_ No_response is considered the same as ao objection
if you have been_notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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 must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signs •
( I S�0 / 1/
Print Name
.2 9 - NCDENR
Tel
ephone Number With Area Code NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
I2T�ZCIO'7 (�F Cfl4CTAT
_ T
Name Of Individual Applying For Permit: `
Address Of Property:
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(Lot or Street , Street r ad, Ci & County)
I hereby certify that I own ro e p p rty adjacent to the above-referenced property. The individual
applying for this permit has described to lie a as shown on the attached
wing th development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
/ I have no objections to this proposal.
a
a
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if you have hen notifiP by CPrr;fied t� j1
W4NER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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 must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date — q -G A,1A,
Print Name
NCDENTelephone Number With Area �AR
Code NORTH CAROLINA DRTN'ENT OF
ENVIRONMENT AND NATURAL RESOURCES
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DEBORAH S. POWELL, R.D.H
F C
i R. TIM POWELL, D.D.S. ,- ttst ;s,53b s
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1295
r 3NDALTK8I6N4fJ PPOH.N9T1RD28 2695V2
15
E HOLLY FtIDGE,NC 28445rill aDA t L_ CI7
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1:0510004961: 0006076479 311' L295 c3P 01/0