25105D - Shultz

CAMA and DREDGE AND FILL
i GENERAL /' NY 25105 b
PERMIT
as authorized by the State of North Carolina
>I ,„„•,, Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC '7+I . 11 ()U
Applicant Namek r> • -,tt 14 Phone Number
Address -1 Li- v ter'S4- E.td 1 r i C-0u rt
City t r, (.3 in; u r- State V"d Zip cS )0q..
Project Location (County, State Road, Water Body, etc.) T f y, 1Th L J( Cf-- CC U n+1-1 i I IS
(_, \ r 1-10tck _ r t, , M rtti,- PP A r_i Cti-,,n f- I
Type of Project Activity 13 &\\_.k••- 8 ,_ Pten, ce-re\ t , a ' Li A X LAJA r a
PROJECT DESCRIPTION SKETCH (SCALE: 0 T 1 )
Pier(dock)Length
1111111R li �I RI
Groin Length r 1111 .. II I •Aim
number .....
1 ill n ,,,,,,,in
Bulkhead Length !'�O i IIImax.distance offshore I t
VrLie_ir - r • ■. ■�
Basin,channel dimensions I� A �1 I I:
II
..
cubic yards
Ill...I 1 iii III /1 1 iBoat ramp dimensions ii on aim
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ii
■ ..m - nom mi
Other11111110 . G I
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11§111j MEM ROI II IIIIIIIIIIII
egill
-I111111191111111111111111•1111111111311
This permit is subject to compliance with this application, site drawing - ,��
and attachedgeneral and specific conditions.Anyviolation of these terms �' J� �'l—
p t � applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void. - . t _ WI 1 -- • I•
This permit must be on the project site and accessible to the permit of- 1 permit officer's signature
ficer when the project is inspected for compliance. The applicant certi- ' 5 . .o(�(� `ko,6 ,ta S().oco
fies 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 ^ 00
been obtained from adjacent riparian landowners certifying that they ' l t 1
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project U (CCI5► ) D"f'+*'i3 13t
is consistent with the North Carolina Coastal Management Program. application fee

CWLFUTER FORM
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ACTION D PI AflON
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•
DIVISION OF COASTAL MANAGEMENT •
• ADJACENT RIPARIAN PROPERTY OWNER NOTI ICATION/WA 7-77.1R FORM
Name Of Individual Applying For Permit: 7 Z-/7
Address •.Of Property: //g 62A474
A/led Bewd V e •
(Lot r S f eet , r ee Road, City & County)
oleos 9
T N
Ma ,urn, /Lld o270 93
- 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 be inc ar000sed . Please write the
Division of Coastal Manacemen t . 127 Cardinal Drive Extension
Wil airctcn . North Carolina . 23 " C 5 or call 910 393-19900 within 10
days of rice; t o_ this notice . No response is considered the same
as r.o objection if you have been notified by Certified Mai1
WA1 �� SECTION
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 reT"i foment.
I do not wish to waive the 15 'setback recuirement.
Signature Date •
1�•
Print Name + ��
F
Te leahone Number With Area Cade