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CAMA AND DREDGE AND FILL
GENERAL )(*.f)
- 0 O16S' -,�
PERMIT Re -tc5,./ cr.) c C
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the Cost/� /al Resgccs5ommission
in an area of environmental concern pursuant to 15A NCAC
Applicant Na
Qrr` hee PhoneNumber(33G) 6�y- �7�
Address . 3 O K 1( b 5'0
City d rec.') S 60 ra State kJ C Zip r7 '1 /I 6
Proj t Location Count , State Road, W ter Body, etc.) ifiy/$S z M A�e 4i. 74C A rig'r e �4 A,
c 14/e a /eK� 11 4 C) ace •. ' -1-- R r Creed a r.J.. s its I L.t C.�..L '/
T p of Project A tivityy Co is 1`r,.,* "Z' X 3 6 0 ' /{, ', -1" /- f I:, X 1 0 ' 4 t4 d d- a'a ' X /O
. i .r. 00t.. R a4" wu'1-Prb rd , Alj co,isfr`�.,410. A (�44/Ihe 4,i X,.,, r ,p4rs CWrt di.r
N r4'�i , ( nee ) Aber W.t i.v c /S A- reT4�1`, 14 ! ( Can 4,` ,a:,i . c 9 /". /� 03
Sha It a pp .�
PROJECT DESCIIPTION SKETCH (SCALE: AI r
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Pier(dock) lengt 14440
O� �,IX,w.�' �.►�.+,,.,.� i. P/ rI t� r'�� ^� _-�
Groin length 61• 'a'kV F/ef 'ti D„r�
t.. r.
---..._ . f V'X 1 O' 4— 4 c.a «_ : .,
number — -`1
+ �-,.� a j. .. .. ...........�.
Bulkhead length ) r
max.distance offshore _
i` 1
Basin,channel dimensions
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yf
Jlit' _ . ,
cubic yards i �iri -�-
._t__—___ —
,-.0 i i
Boat ramp dimensions Pr ceN V .'V
OtherL'.�evd /alert°' 19`0 . - , 1
j ipo1o, -i K � x � r ,
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83 i s3,
I 1 1
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any e-r____ <--paa,..e2 ----...__—___---
violation of these terms may subject the permittee to a fine, I applicant's signature
imprisonment or civil action; and may cause the permit to be-
,Icipi1/4.„„k_
come null and void.•
'6�—
permit officer's signature
This permit must be on the project site and accessible to the
Y
permit officer when the project is inspected for compliance. —� � b
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The 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 n J
adjacent riparian landowners certifying that they have no , J
objections to the proposed work. attachments /
.. Ck J59 �
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
. Management Program.
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.
•.7• sue.
RIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER. FORM
Name Of Individual Applying For Permit: )er-
Address Of Property: 86 4/ .�
P
(Lot or Street #, 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 to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
• /,/ I have no objections to this proposal.
If you have objections to what is being proposed,_ please write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilminaton , North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail
•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift 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.
•
•
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Tele hoe Number With Area Code
RIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: Jeerlli
Address Of Property: L'6 - ,4/1suir
J
A/c, avvyd&A
(Lot or Street #, 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 to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being_ proposed, please write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilminaton , North Carolina , 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift 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.
•
4 _427:25 /__
Sigp.atilre Da P •
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Print Nafie �®
I' 37)6' - S q""- Ei0EE1--INIF t
Telephone Number With Area Code
•
TERRY L. LEE 66-112/531 15 9 2
LIC. 2230660 5212965601
PH. 336-674-6862 -
L,_ ••
5825 HAGAN STONE PARK RD. Oats
PLEASANT GARDEN, NC 27313
TAY CAMA I $
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CM lANN,NO AND i A GROANY IIIII
2835 RANDLEMAN ROAD i
G�JREENSBORO,NC 27406 o D
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