15929_LEVAN, KEN_19960124

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Applicant Name
Address
City T1
Ott t CU (OuPJTY/
9
CAMA AND DREDGE AND FILL 015929-�
GENERAL
�� C®P
PERMIT ,� 3
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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 00 °' 'l
ae� L.Pi/a:-r Phone Number
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Project Location (County, State Road) Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION
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Pier (d6y�ock) length x 5
[tJ��x2yn..1 f}XFi'� �/fug
Groin length �4'4
number —
Bulkhead length
max. distance offshore
SKETCH
State NC
cel.,
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zip -1
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Carr-
(SCALE: 11,,4,_ )
1 �rro �p cBoo
(w rowr�CA� per' 8
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Basin, channel dimensions
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cubic yards
Boat ramp dimensions
Other
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71191D M h /�
CV441 '&Pr er V
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
% 4 X"via, ,
applicant's signature
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1 permit orncers signature
issuing date —� expiration date
attachments //O D
application fee �" ��'' L T Y- '

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150
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POST OFFICE U. S. DOLLARS AND GENTS
YEAR, MONTH. DAY -
SERIAL NUMBER�.'�
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CHECKW RITE {.• �njV .� _� .
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IMPRINT AREA
PAY TOIV
lam" FROM
ADDRESS `
COD NO. OR
USED FOR
6 2 50 21,84 2 30��'

ADJACENT RIPARIAN PROPERTY ONN NM STATENIENI I'
(FOR A PIERIA100RING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent tois
(Name of Property Owner)
property located at Z � /94�6z'%44Z �;' � ,r,. ✓� ,
(Lot, Block, Roa
onin - , N.C.
(Waterbody) (Town and/or Cou ty)
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
pilings/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:
(To he,fdled in by indiizdual proposing development)
0%i
i
Sig tore
v �
Print or Type Name
Z 7 — l Y -2--
Telephone Number I ,
Date: f
1

ADJACENT RIPARIAN PROPERTY ONNT' FIZ STATEMENT
(FOR A PIER/A100RING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to An,- d 's
(Name of Property Owner)
property located at
;2
(Lot, Block, ad, etc.)
on '4'" 4..,- %] in
(Waterbody)
(Torn and/or C16unty)
. N. C.
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. Ielstand that a pier/mooring
pilings/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 DRAWNG OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
-cam iY �
•w
IF 10
04
I
Signature
Print or Type Name
Telephone Number
Date: /- a & -
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