23773D - Clark

LAMA and DREDGE AND FILL
G - E N E R A L i k 237'73—D
• 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 1-4 •' a-0 c3
Applicant Name bO U&LA5 CLJk 2 k Phone Number 1%O 7 q l 09 4i-a
Address &3 O q e SCt-4-o C 1
City U .,)i L.v (ramc t State N.) C� Zip o�S4-0G
C.) r
Project Location (County, State Road, Water Body, etc.) Loy .j.- Y. Qu rN e SO-0.C,(v. (3,....1
Q Q-cr Qd. . / ,� • -a-f �.i u•c t- / PJ E- r CAD ,
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Type of Project Activity ?t,r U ' i ?(r-r
PROJECT DESCRIPTION SKETCH (SCALE: I,-7 )
.. . ., . „gym � ,
Pier(dock)Length i ' £ I1. `
± "at S 't 4- ,,,,,_ Ai 11111 III , Zilli 0
Groin Length 'MPS , ________,___ . ._. ..._ inewein
number
L 1 li my millimis
Bulkhead Length
max.distance offshore d €
C 1 1 1 iniamar..-
Basin,channel dimensions
_ .,,,,,,34,, ..N.,4,.t., Li lei iim
_ _ . .
cubic yards
1IIIItlIstiastmr t�rsrirs _ .M....— si `
s pi<
Boat ramp dimensions
Other r
e
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INN
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This permit is subject to compliance with this application, site drawing .C, G a(
and attached general and specific conditions.Any violation of these terms applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and9.....)._45.1
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 signature
ficer when the project is inspected for compliance. The applicant certi- 1 r 1 q - Co ii I Cl —DU
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 —1 IA- ( Zp 0
have no objections to the proposed work. attachments

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C nN C3F s acTAT s RT.
GEmENi
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Name Of Individual Applying For Permit:
o vG‘.y.l' eLA+a>2K
Address Of Property: 7,a ' /ei a'', ,tooNi0
.694yyC.e c do.tJ7v
(Lot or Street#, Street or Road, City & County)
I hereby certify that I own property adjacent to the above-referenced property.
applying for this permit has described tome as shown on the attached p P drawing the The individual
they are proposing. A description or drawing, with dimensions, should be provided with
letter. ith
I have no objections to this proposal.
a
a 7 _
F r
l Prtified M 1
----ems� i v a��
W' R CFCTTpN
I understand that a pier, dock, mooring pilings, breakwater, boat house, Iift or sandbag
set back a minimum distance of 15' from my area of riparianunless w
a�s must bewish to waive the setback, you must initial the appropriate blank below.) aived by me. (If you
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
-/
Signatur _ i - - 00 Aril:A
Date
Print Name
NCDENR
Telephone Number With Area ode N /�v�iR�
NORTH OLINA DM.ARTM=NT OF
ENVIRONMENT AND NATURAL RESOURCES

•
Name Of Individual Applying For Permit: Qr lie z ii s
Address Of Property: Mve-P
C�ogD LsJ/cn7iv6Tp4/
/t/r4.) 7/Hti o ✓f/e a yell7-
(Lot or Street#, Street or Road, City & County)
I hereby certify that I own ro e
P P rty adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided wi
th thistits
letter.
I have no objections to this proposal.
v ,
a ? C Cr A A
` V
it Coy 22VP 1 .e T)ptif AL b`, cert1T l P -
iAnm SECJjp T
I understand that apier,
set back a dock, mooring pilings, breakwater, boat house
minimum disan a of 15' from my area of riparianunless' lift or ds by me. must bewish to waive the setback, you the access waived by me. (If you
musi initial 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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ATC.
Date
,—...„,ltr
Print Name
N
ENR
Telephone Number CD
With Area Code
Nam--n., c OL.INA RTMNr OF
ZNVIRONM=,.7 AND N,CPURA. R SOUR,^_

I DOUGLAS C. CLARK NCDL 4036258
• 1495
NANCY J. CLARK NCDL 8090243
yli,,,� '� 6902 ESCHOL CT. PH.[phone] /
WILM GTON, NC 28409 C /q ;20QQ 6 •6 2/518 �m
ass 5�Pay to the i ‘7
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; Order of / w_ .u..-_,�
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