15958_HILL, LARRY_19960325

O
CAMA AND DREDGE AND FILL%�i.
GENERAL �� �����r
�
�UV l
PERMIT 0��
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 -7 0 1 1 0/ -e t S r G'
Applicant Name �C� ��� 't r t Phone Number
Address
City /L' -P Q Y')r' t State ` Zip (� >J �i `7 0
Project Location (County, State Road, Water Body, etc.)
Type of Projec�tj Activity
I! C- C" !/l{ /� 1 /' 2-/ 7 C L J� // 4 /T
PROJECT DESCRIPTION SKETCH (SCALE: �% }
Pier (dock) length Cr,�b j`f c., j l t. { �� •r �! S '"�
-7
Groin length !w? K C C"' Lit% 7 rJ) may. r n _-p
number
Bulkhead length / "" t- n p r
maxi distance offshore
Basin, Channel dimensions Lt Ve J /, 7( 1 ; - '
r
cubic yards 14
Boat ramp dimensions
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies thatr
this project is consistent with the North Carolina Coastal application fee 501�•`'
Management Program.

LARRY J. HILL NCDL 1915617
NANCY S. HILL NCDL 1703971
2629 WEYMOTH RD. 765-5683
WINSTON-SALEM, NC 27103
6 3-1 571 3355
572030782
19��
PAY TO THE s � �-
ORDER OF
DOLLARS
Central Carolina Bank
c cand Trust Company 571
W s n Salem, Nonh Ilna 27l 13
�' M 7Sg5 (a
MEMO�A w A U 2 M 1 fife ------- -"
i:05310046Si: 57 20307 u' 33

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3 • 41 L� 's
(Name of Property Owner)
property located at l D C flu R C Id
(Lot, BI
Road, etc.)
on ! C w v� in r�= e 'T , N. C.
(Waterbody) (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.
IR DRAWING OF PROPOSED DEVELOPMENT
in by individual proposing development)
)06
C�(G'4✓J G c/�
Print or Type Name
91l-zz3
Telep oh ne Number
Date: -:�' — Z / - ;�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �f}-�a,�/ s, w-, LL- 's
(Name of Property Owner)
property located at l R-r- c a:J-c._
(Lot, Block, koad, etc.)
on (.v r.✓ , in G N.C.
(Waterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
M
0
--Z v % ' fT
Signature
Print or Name
W 0 p r'd 0-7 7 f
Telephone Number
Date: 3 , a-o? � J G

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