20342D - Matthews

CAMA AND DREDGE AND FILL
i. GENERAL NN2 020342—`�
Jr_
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 71/ ., vo .
Applicant Name J i C_N. / e,w5 Phone Number(9tO) - D33-
Address a//0 SN-D,feiNg 2:R;V€
City -7vesA,'f 1;4 t1 State� NL° Zip � 3'//5
Project Location (County, State Road, Water Body, etc.) 5 -e ,grJJ Nl 39w<5 C4144/!/N /em c/ s' 4 A •
Type of Project Activity / / e4Wit.I DC F e/( T_r/,YI ICI) 1. Mi/✓G iii.f,e, /&IN iz--- +qUY/)
- 4 i/ 1 ovrYhoN r o' )A/ •?Sav 5H4i( ,9Pi1/
ie (on,-'RC Y 7p '/t- D,i^- -Z 54;/ c4,fi// `'u' R i;,b; G- ,oe km;-/ 44-6 Ai.c, 3 4,/4;ti y
PROJECT DESCRIPTION SKETCH (SCALE: /' )
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Pier(dock) length /./���0
: 1 ;____ . RA'(IA'r, ti(4/vA^,---.4-.._,,_ i. ,i7 II —
Groin length f.,�_._ I
- 1
1 I 4
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number j
Bulkhead length b
t j i .
Yf -s---,ten... _
max.distance offshore z I I j
i i I ( I
Basin,channel dimensions j� � I
cubic yards IL l pit- j� j
i
I iI
._.... --.a..... 4 ..
Boat ramp dimensions 1— r
III Other I 4 t3 . if
..i' jI
i_ i I f
j
4.
55 ' [o't '.-O 3 .
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any d /1
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.
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance. I/ c
The applicant certifies by signing this permit that 1) this pro- 01 JS-[x., /O-0/-0c
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 7fi SUS
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project is consistent with the North Carolina Coastal application fee 1,,"/f 4 F100
Management Program.

DTV_TSTON OF CO AST AT,MAN4GEMENTT
ADJACENT RIPARIAN PROPERTY OWITER NOTIFICATION WAIVER FORM
,r
Name Of Individual Applying For Permit: � / •Q e . Q t"7- .'// c�J S _
" e
Address Of Property: 27/0 5 re/rje a;
7;;;,,.. 2i/ Q ell /t/C, ,9
(Lot or Street#, Street �r d),
or Road, City & County)
I hereby certify that I own property adjacent to the above-referenced ro e
P P rty. 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.
Tf you have ob.
Mangy .m n , 127 1�Torth f�rdinal T)rive, Wilminotnnr�a ,T. �
3900 within 10 clays of recce
is Duct r th c
if you have been notified by Certified Mail din
WAIVER SECTION
y`
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 areal of riparian access unless waived by me. (If you
wish.to waive the setback, you must initial the appropriate blank below.)
•
i•••/,�/s V 2/7 / I do wish to waive the 15' setback requirement. _---
I do not wish to waive the 15' setback requirement.
AI
Signature to
/iQ rip n /r - / 7- 0 o �`��'
Print Name
9/9- 3Z6-o/04- NCDENR
Telephone Number ne Numb.,r With Area Code NORThi cAROLINq D�i�„R of
ENVIRONMENT AND NATURAL RsOURCS

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