14875_PENCHANSKI, ROY_19951011

CAMA AND DREDGE AND FILL
GENERAL
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 0%jf%. IA 4O ar: f • 12G
Applicant Name 'f;� G €r„ {" Phone Number
Address ei .4
City ''' �'aX State .t/G zip �`8<
Project Location (Punty, State Road, Water Body, etc.) 7.
^�
Type of Project Activity =' r /' r L4 '4' ist cx PF•,,o c ap r f' •ra. -�- ` rx,r'
W,!fYt,2_ cY A /;;.% ac t
A" C - 'o- c-J . .Ar.,; r s
PROJECT DESCRIPTION
Pier (dock) length
SKETCH
(SCALE: As ?
�%
it
{-R✓�---�_
` KJ� &
Groin length •-
_
number
Bulkhead length
max. distance offshore�-
Basin, channel dimensions
W I 1y
49.
'Pr l�
cubic yards
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.
attachments
applicant's signature
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that , ,
this project is consistent with the North Carolina Coastal application feerJ ` ' ?J<
Management Program.

%:�:� LAW TRUCKING SERVICE
de�
112 CREEKVIEW COURT 919-249-0523
MERRITT, NC 28556
FIRST CITIZENS 411
jJ Aj�jII Fhsl-CII@ens Bank d lsusl Company
l��rf�J�l����B/y�boio, NC 26515
is
i:0 5 3 Loo3onioO L LO 203r. LiI'
19��
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3130
66-30/531

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
go)/ Q. o r-'�j" S'k a 's property located at
(Namb of Propertv Own )
(Lot, Block, Road, etc.)
on �} N—t4e5 CN-.e_ )C- , in _ ( 2r�l�c�c� , N.C.
(Waterbody) (Tow--;r� -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.
I wish to -have 15' setback observed. -----------------------------
-----------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
IU\.l i » D
Signature
Print or Type Name
(4-c)
5'/LI- - -CI STY
Telephone Number
ID e-'-1)6e.\o—

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
NAme of Property
Lot, Block, Road, etc.)
on �- i GS G �'�P. , in Ia IM t l6-U , 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.
I wish to have the 15' setback observed.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
G R%i�i2Ok ,piae/
0. J/)
SiTTg}fature
Print or Type Name
'7'7 %
Telephone Number