16129_ROUSE, DWIGHT_19960507

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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 Com.msion
in an area of environmental concern pursuant to 15A NCAC �� G>/ �� /
A��' 5 4A r^�f '�` Phone Number � l � - �4 � � d 7Lr
pplicant Name
Address 1 7 U t1 • c 4-, �, t's»
City I^-} i �"" �. � < State � e Zip �
Project Location (County, State Road, Water Body, etc.)
ie
Type of Project Activity �/
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PROJECT DESCRIPTION
SKETCH ��; ���� -(f (SCAt E: �, )
Pier (dock) length
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Groin length
number/
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Bulkhead length
max. distance offshore
Basin, channel dimensions
96t
cubic yards
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Boat ramp dimensions
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ther
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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.
Q� applicant's signature
permit officer's signature
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issuing date
expiration date
attachments f/► r 7 /4 / Pee Y /L 0 a
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
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application fee

ELTON W. ELLIS JR 0909
NC 1855620 PH 919-726-6775
P O BOX 691 68.152/531 CC
ATLANTIC BEACH, NC 28512 7j 19�
Pay To The/> /� I $ Sv a
Order Of f /'
Dollars
Wachovia Bank of North Carolina, N.A.
Pine Knoll hores, NC 28557
Memo-
11:053LOL5291: 5464 LL7L3silo 0909

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E. W. ELLIS, JR. & SON
DOCKS, SEAWALLS, CARPENTRY
CONSTRUCTION & REPAIRS
BOAT LIFTS TO 70,000 LBS.
TELEPHONE [phone]
Post Office Box 691 Atlantic Beach, NC 28512

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ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to
0
located at
is property
, on
(Lot, Block, Road, etc.)
in N.C.
(Water bodY) TTown 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 understand that a pier 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 that setback requirement.
I do wish to waive that setback requirement.
j.gnaLure
Name
F/ 2YU
Phone number

•
ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to
's property
located at
(Lot;,/Block, Road, etc.)
(Water bodY) (Town and/or County)
on
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 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 that setback requirement.
I do wish to waive that setback requirement.
Signature
Name
Phone number

011- 6
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