16386_MCDONALD, MARILYN_19960716

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CAMA AND DREDGE AND FILL o 016386 --
Y_ GENERAL c-v/
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
Applicant Name r l% �y r� Phone Number
Address - }
City �<�.1 i ��! m d, 'r State Zip -,/J
Project Location (County, State Road, Water Body, /etc.) F �Am
Type of Project Activity'�'w
PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
4,
s
iC.
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.
d-�G( IF r. l Cl-
A / applicant's signature
permit officer's signature
issuing date expiration date
attachments " /' o 6 _
application fee

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Vi4e,WoAT)4 Fose-of- rs?�
I property located at LOT Z
/ vxe- !-�y',-(rs SmPt olripto
lock, road, etc.
on 4JCOU "t Jt/Et_ in Qk1f#3-M- , Pt('Zl'//�"C.o GO, , N.C.
(body of water) (town and/or county)
The proposal has been described to me as shown below: the development, a
pier/ ulkhead/ structure, and the proposed location, and I have no objections
(circ e
to the proposal. I understand that if the development is a pier, it must be
t,
set back a minimum distance of 15 feet from my area of riparian access unless
waived by me. I do do not wish to waive that setback requirement.
circle one)
Description and/or drawing of proposed development: ( to be filled in by
individual proposing development.)
I
�v
(Original must be retained in the Inspection Department)
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Signature
fs ti-L C' o aC(-(T L- _ L07 0(o SSE
Name (Please Print)
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14-21

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ADJACENT RJ. P. ARTAN : RO Y Fp,,re () ER SxAiQiyNT
I hereby certify that I own p2-operty arljacG,lc Co
- --»*s properry located at 10 ��� /CrtT T� t1c, �/-�,'
` 7�t, bloc c. ros �-h`L'�'`L�-'� �i('Y A-
bn r�ffi to)R;1I1t . etc:
(body of water) N.C.
The propvsaI has bean described to me as shownnd or county}
below: the development, a
t�!--,ul structe}reand the propo,ed location. and I have no objections
to the proposal. I understand that if the development Is a pier, it must be
set back a tuinlzri um d.israric a of la feet, from my axe.a of rf arian access unless
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waived by arc.- . T/1ah do not wish to waive that setbzck requirement.
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*�*Pry:rink,tks:ie**?e�irie��t�*,tfrit*irdc�iC��Fi.-�*rF�,tit��}icfe***h�C�rsF,�k3c�F#,kir�4*�i�tst*�k�E�,tfr*iei:+k*�r�tet7r�k�t
indiviptivn and/or drawing 4 pr-opose.d dcvelopment_ t to be filled in by
indivicIn:�l Prgposing development.)
- al�eikxtitsrxyc�t*ic:l�4ictiria�Fk�rRvr�kv�iF�*,�k,t�**�cir�k�ksti�****,�,ti*,t**yklrik**ik**#*ir*�kk�k* * itfti*,t*rk****
(Original must be retained in the Tnspe t4On Departn nt
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