20129D - Blake

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CAMA AND DREDGE AND FILL lij;� 920129--D
GENERAL
PERM I TY9/.."
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coas I R sourfces ommission
in an area of environmental concern pursuant to 15A NCAC / r t I n
A licant Name L e r T .g/� kr Phone Number 3 6 6.2l - 12S�q
PP I I
Address "7 S/17 Y� A cr y V1 /in Pee)
City Qr,D A s J v/ti+ .r+, 4 State Zip
Project Lo tion (Coynty, State R ,pLeater ody,etc.) ` T A -1--
4., /�ri b V k��� Al Vil�✓ b fr f'A D uM� s fa -o `l
A 1 J, GI c (•or (4 IA +%
Type of Pr�iect Activity �L ' r�. � �/�n f ('
5 4 4 1[P h tv & l / !q' ( 3 H IIP. iv r•4/ GI r- 0 / 1� 1 ! �l� 1 c e n Nvl f 11
pr�p (r \! /,ne .Zb ' )41rlc� w-r D f n{I)A4' or1 0ci /< 7 rPc / n(/� -Pc1S ( rn
Pr- p-r r -` //n C . /4 ) ) !r a✓l d f�/-, -a) b -P' 7 l-1 . 12 I l D D skit rt
ROJECT DESCRIPTION SKETCH (SCALE: I® / �� �`� �)
t , < < .�� I - I I T Q
Pier(dock) length j , _I _ _
N 41 � � -
Groin length 1 '
i
I
i—
number
Bulkhead length F -- (1 / w
!1n `�r. .r e �c/�vTCrI o
max.distance offshore
+` O '
Basin,channel dimensions
cubic yards '+ Pr po5.e f 4-46,
au a,6'
Boat ramp dimensions / IZ,.
ALA
IL/ i_. ,
Other •U fa
/; / FOti'� Atosf iO4 R '1re,
h
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any ,k-- 62
violation of these terms may subject the permittee to a fine, � -
imprisonment or civil action; and may cause the permit to be applicant's signature
come null and void. /y • Cca
Qi
This permit must be on the project site and accessible to the l/� permit icer'ssignature
permit officer when the project is inspected for compliance. L,---06 - OD n -�1 OThe 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 1 1 \
adjacent riparian landowners certifying that they have no '^if 4- ( ( 0 lJ
objections to the proposed work. attachments5 1
In issuing this permit the State of North Carolina certifies that (7v
this project is consistent with the North Carolina Coastal application fee '
Management Program.

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U ?

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DIV7STON OF COASTAL MANAGEMENT
ADJACENv RIPARIAN PROPERTY OWNER NOTIFICATION WP_�
`v3R Rpm
Name Of individual
Applying For Permit:
Address Of Property: Oft/ Hic
m 3r Ci
(Lot or St_eet frL, Street or Road, City & County)
I hereby certify that I own property ace?
reverenced property. adjacent t to theope_ty. The individual applying for this 'permit
above-
referenced
described .to me as shown on the attachedevelop has drawing the development
they are *proposing. A description or e_sions
should be provided with this letter.
drawing, with dimensions,
I have no objections to this proposal.
If Zrpu have pb1 eCti OnS to what is bei nc
- propose d. Please wr_;
te the Division of Coastal Ii _a ent. 127 Cardinal Drive ExtenSiOn.W'=minQtDn. North Carolina. 28405 or call 510 39S-3500 within 10
of receipt of this
notice. No r
as n0 Obi ecti eSpDT.1Se i S considered on i f You have been notified e the Same
-- _�d by Certified ed Mail
WAV _a_ SECTION
understand that a pier, dOCk
house lift , mooring pilings brej
fromu , or-Sandbags must be set back a m;n , _ eT-r boat
my area of riparian access unless waived �m .distance Oi IS h
to waive the Setback, you must -Initial ti l by Pp (Ife wish
below. ) L-c- t_-^= cDD?'ODrlate pl�`K
•
T do wish to waive the 15'S__;.
ack 1lJ/ t_.
I do not wish to Live the IS'Se tb_ck regui rament.
S i gna tore 6-2 i- i< 0
ate
c
Print Name
•
Tel phone Number With Area-- Coate

•
• OWN= NCsT ;76E ON/it7" R 'POP
7.1
r,
io -
Nam Of
l Applyi�g For Permit: ve `7.- Pi_ci�j
e
Address Of Prop=_r ty: '� f-. No if ,
(Lot .....
or Ste T
u
.-L a, Street or R.o+.d
City Co ,r,ty?
1 hereby certify that 1 own property adjacent
to the above-
referenced Property. The individual applying for this ben f his
reser . �o me as shown on the attached drawing the d=welo ttY are prpposin Adsc? ` on or drawing, with 'i an 4ons,held b providedit this letter.
i objections nave no objectithis to prODOsal.
Ti: vourav= obi ec�i „
L_o,s to what is bei Tic r Div-;si pn p= Coastal h',_ra � ' OD05eri D�c`S`
North Carolina. 28405 or l 1 O 3 O - 9 ^=aT_1S1 On
days of ra^=;nt 0= this �� call C _.S_ g
as notice. .No r=_snoT oo wi t;,;n ., o
no obl=Ct4 On i= VOu have been -notified e 5Jv Cer` f d Tv5_onsidered tl•
a Sam?
WIZT _ S3CTION
I- tTn�arst,:.3D, that'=L a pi_r, en � _
d . S , i ch, moo = pi l iincs _ t__
_=� my `� O_ andhags ,�n,qt he set back a mini , jstance , 1S'
., riparian access Tnl e_ _az distance Y p= i ,
tol wave the setback, you must S waived. �� �'' -'
below. )
initial`-^l he �__ y011 wish
cpp=�?p�.:tom nl
do wish to waive the 1.5'sethach •
do not wish to waive the 15'sethach require. art.
•
_,,,f 6-/ir".- 0
- u e
to � � .! -act e ."'�«c
��'/o -.�70 - v�9
Number With Z ea Code

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BERT W. BLAKE, JR. 616372 12 4 2
53
4517 YANCEVILLE RD. 372099710
BROWNS SUMMIT, NC 27214 Date (S!r-46-'0O
Pay to the n �.y, `r
Order of 1../ /o13/Oj1� Or CQ5j`!e/ thetivIPp r,I I $ S0/©O
I v Dollars
C cB Central Carolina Bank
and Trust Company 372
Greensboro,North Carolina 27408
For Pe}ni, (Y 84.
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I.053L004651■ 37 2099 ? L011a L242 elpaola9'