15120_LEE, TAMMY_19960925

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CAMA AND DREDGE AND FILL . � 015120 fi
GENERAL � I
-1� 0 C T 0 9 19%
PERMIT
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 -'"�'-� 1 1 i
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Applicant Name - Phone Number (166 - 4(Q!:7 (4-1 1
Address !t t ni,
City \!J I L M 1 K I L—M.L( State f i C_ zip 2b,2 4_,C)=
Project Location (County, State Road, Water Body, etc.) A
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Type of Project Activity V�L1L11i=.,�K �1� �f1 �' 1 �yt%ti-/1F►`1`�
PROJECT DESCRIPTION
Pier (dock) leng ti1GI j
SKETCH ? — j-� i _. 1 / (SCALE: v So' )
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�LL
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J`I� K,C'.�7 r rA I L I'rl
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F-W Kta 1 1 Iu M t3L I _ IAA �vK I tj S
Lid VL-
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other X UNCL
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This permit is subjb; f tb'-e'o'rfibU ice 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
M Z5 2 ; i
/ issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee'" T
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION AAIVER FORM
Name Of Individual Applying For Permit:
Address Of Property:
(Lot or Street, Street
or Road,
City &
County)
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. P_ description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the
Division of Coastal Manacement,.127 Cardinal Drive Extension
Wilmington, North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no objecticn 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 distance 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.
�`
Signature Date
Print Name
Telephcne Number With Area Code
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DEHNR

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER FORM
Name Of Individual Applying For Permit:
Address Of property •
(Lot or Street, Street or Road, City & County)
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 pr., ided with this letter.
I have no objections to this proposal.
If you have objections to what is being Proposed,-nlea_=e write the
Division of Coastal Manaaement, 127 Cardinal Drive Extension.
Wilmincton, North Carolina, 28405 or call 910 395-3900 within l0
days of receict of this notice. No response is considered the same
as no cbjecticn if you have been notified by Certified Mail
ii+AIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbaas must be set back a minimum distance of 15'
from my area of riparian access unless waived by me. (If you wish
be waive the setback, you must initial the appropriate blank
below.)
I do wish to waive the 15'setback rEaUire:�en _ t.
I do not wish to waive the 15'setback requirement.
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