15948_HARDY, GREG_19960208

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CAMA AND DREDGE AND FILL 015948--n 'I
GENERAL - �t
PERMIT r&1
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Co AMsson
in an area of environmental concern pursuant to 15A NCAC
Applicant Name �'� ���%�� Phone Number �'� SQL - X,7
Address2--
City State _Ais✓ zip���-5
Project Location (County, State Road, Water Body, etc.) x-2 13,29, ("el,1 —"4-1
Type of Project Activity rM" S
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length `
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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CQ_ -
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.
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appl' nt's signature
permit officer's signature
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issuing date % expiration date
attachments __ G 7N• &OU
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee #, _5,' /`%80 h2� 6-29,PY2Y/

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62502484241 9" 12
SERIAL NUMBER YEAR MONTH, DAY
POST OFFICE - U. S. DOLLARS AND CENTS PAY TO � CHECKWRITER
IMPRINT AREA yJ i+
ADDRESS / "
FROM
/V p�s' ADDRESS P �q
"I" OR
USED FOR
1:00000600 21: 6 250 2464 24 Lu■
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ADJACENT RIPARIAN PROPERTY OWNER STATFAIENT
(FOR A PIER/,1100RING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to - -, -� 's
(Mime of Propert Owner)
property located at _ 5 A / .3
(Lot, Block, Road, etc.)
on ")U� in , N.C.
(Waterbody) 1 (Town and/or Cou y)
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/mooring
piling s/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
_ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
Tele hone Number
Date:
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