26221D - Dorman

CAMA and DREDGE AND FILL '' 26221'
G E N E R A L
PERMIT
as authorized by the State of North Carolina
> :....- Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC -7 H. 1100
Applicant Name J Aii T pop.tnrA- Jc/' F S IfPT(t.►hone NumbA'le �� `
Address A )0 I —A e x ce E E . l P -5To N Co r{
City W t LtM 1 N State N C. Zip Z$�-O 3
Project Location (County, Road, Water Body, etc. O 5 1 V
ty, )C�,.- T ( O� � �� T1.1 Lam'[ t to t.,.? �P. /
-yht N Vr, A t\ t'PJ N ?. cir IAL-j tip d-i-petu ver co.
Type of Project Activity pci\CQ 64-1 5't"1
u,L{mil-11
1l9'-a -- 1a-► f" I
PROJECT DESCRIPTION SKETCH (SCALE: s I r C0 )
:;,
Pier(dock)Length !� ` `�_
Groin Length '-....i.i.�
4-'frotk ,. .,., itim, _
number .., � �� L
Bulkhead Length +1 1 1-'� t ��" Ain MI
max.distance offshore � . ll
^ etBasin,channel dimensions
cubic yards » )1:6 • p .._. .
Boat ramp dimensions i
I
Other wijk \— .
a
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IS
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This permit is subject to compliance with this application, site drawing WA/( Cwr-
and attached general and specific conditions.Any violation of these terms applicants signature
may subject the permittee to a fine, imprisonment or civil action; and r
may cause the permit to become null and void. -
This permit must be on the project site and accessible to the permit of- permit officer's suture
ficer when the project is inspected for compliance. The applicant certi- 1 a- ) 4 - 00 3-t 4 - 0
e
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
been obtained from adjacent riparian landowners certifying that they 71-4 % 1 c) v
have no objections to the proposed work. _ attachments

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit m S JA n U D i2 m A r)
Address of propertyLD bj/ A le i i 612-
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 of notification.
Please initial below if you have no objections <71f tqELlf: llfl t� /
PEP p I I objections this proposal R /� ��l fbu�q
Pave f lG to proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 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 or
sandbags must be set back a minimum 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.
76
C Signatu e & Date
2 Print Name
g iq -7?z-126 a Telephone Number w/ Area Code
PLEASE SIGN AND RETURN TO; F&S Marine Contractors,lnc.
P.O. Box 868
Wrightsville Beach, N.C. 28480
Phone/Fax [phone]

• SENDER:
0 ■Complete items 1 and/or 2 for additional services. I also wish to receive the
Cl) •Complete items 3,4a,and 4b. following services(for an
H ■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. c
j •Attach this form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address •1
d permit. c
cu ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery U
C •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee. .
o c
o 3.Article
/A�ressed to: 4a.Article Number c
a (�sJ l'Ld i 1i i �9 Obb bb aoe14 3Io 2$JI 7 a
E i L RA L 4b.Service Type e
8 rt MA,, -Sort A) en, 0 Registered L9 Certified e
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0 Return Receipt for Merchandise 0 COD
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5td7j 7. Date of paliv
t_�' y 2000
• 5.Received By: (Print Name) 8.Addressee's Address(Only if requested 1
and fee is paid) c
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g 6 Signa Addf ssee or Ayent)
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x771/
PS Form 381- . December 1994 102595-97-B-0179 Domestic Return Receipt

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