16284_FAINCLOTH, WILIAM_19960529

10
CNMA AND DREDGE AND FILL
GENERAL
PERMIT
tVY 0 284
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal R. sources Commission
in an area of environmental concern pursuant to 15A NCAC />• '' `
Applicant Na o f ' 1 l 0 — � ° F C� 1 J' =� Phone Number
Address % '7 c.� y, 1`� 7 L'��
f
R P0,/'
City State 4-- C Zip
Project Location (County, St to Road, Water Body, etc.) �_ C `' f `"'
l t �r R gyp-_0 � !i G' � ' ,f C � _,P � rot
Type of Project Activity �� <.• , L y ° tia' %� -�' l 4� 1 / Gt' i, —
,� ''�/f lJ ' ° b^ I �J .i % I 'i,�.' �'i� ;* 't �+ •-9 � r_P � !'` � _" 'i- � i, ,• � �i / ...^ 1 Fet�ry ��..�
PROJECT DESCRIPTION SKETCH �:' /� 9tr{ (SCALE: )
Pier (dock) length if
Groin length b ��✓it� �+�� I S� r j /" ` r �'.
number
Bulkhead length
i
g
its
max. distance offshore
l
Basin, channel dimensions
> cubic yards _ r r 5 r >
i
Boat ramp dimensions
- a —
Other }
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
.l'111i4}! 1'v�1�fi-i'f�
Oro
i
o�
applicant's signature
it officer's signature
issuing date expiration date
attachments � C ` P 0 f
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application
Management Program.

William H. Fairclot(t, yr. 11193
VDL 6002781 Ph 919-504-2000
1512 Front St
Beaufort, NC 28516
Pay to t ,
Drier of
=CITIZENS t.r
BANK1�iY Flrst.Clll:ens Bank ! trust Company
Morehead Clty, NC 28557
ror- --
':053 1003001: L3 L741,2g92ii1 3776
3776
66-30/531
s�0 PID
Dollar

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-FROM W.H.FAIRCLOTH,Jr.
PHONE NO. : 919+504 2000 Ma.y. 06 1996 02:?6PM P1
MIACENT RIPARIAN PROPrPTY OWNEn STATEMENT
(FOR A PIER)
I heraby'cortify that. I own property adjacent to
' s property
located at 1�/;L rf OAIl 5-F , on
/� (LOti� 81dCK� Kot3c�� a c. )
�+ti.S P fi i n
'- Water Body ('town an ar County
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.' -
I,do not wish to waive that setback requirement.
_ I do wish to waive that setback requirement.
Description and/or drawing of proposed developmanti (To BE
FILLED IN BY MTVI UAL PROPOSING V1".rX OPMM?T)
C C��Cis���ei /,.(ye-
V,
R��L
Q�
gn ture "frleArr- ST.P6ta''
�,yri5 �A✓/S - -
Name
910 — 6,7 A . 7000 (off
Yli4 A R R tT. lAl til. R Y
Qio - 69�
6P 693S-
FAX
HE
ram,.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
/ lI hereby certify that. I own property adjacent to
ll<s . 's property
Name
located at �5�� 2 fj2 d�on
/� (Lot, Block, Road, a c.)
I/ft S c_l'c P P ,� i n dea-CC . N. C.
(Water Body) (Town and/or County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me. -
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Z„ e.
f
/ Signature
Name
7a-�_`Z9 L3
Phone Number