11768_DERBY, WJ. & MAXWELL, J.L._19930419

Applicant Name
Address
City
Project Location
CAMA AND DREDGE AND FILL
GENERAL � N° 11768
PERMIT
LJas authorized by the State of North Carolina
+I Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Phone Number
unty„ StatelRoad,
Type of Project Activity
State �►,, / IVCzip 7Si
ater Body, etc.) L716 z L1L14 v 5 � _ ' 06
0(/ _
PROJECT DESCRIPTION SKETCH
PieE(dock) le h
t �k�C.i t
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
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 permitter 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.
(SCALE:
JI/Ai
Y4, D lq3 A.aa
issuing date
attachments �! ' l 00
applic nt's signature
pprmit,officer's signature
7aW/ 3
expiration date
In issuing this permit the State of North Carolina certifies that /� 0
this project is consistent with the North Carolina Coastal application fee
Management Program.

90CAMA AND DREDGE AND FILL K-
GENERAL �©p
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 15 NCAC
16
Applicant Name l r�k l" v �' G .Phone Number
Address
City State /r1/� Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH �I 1 % (scat_E: )
Pier (dock) length
Groin length
number
J1
Bulkhead length
max. distance offshore
Basin, channel dimensions
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.
% applicant's signature
permit officer's signature
issuing date expiration date
attachments -711
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

W. J. DERBY OR HOPE S. DERBY
PH. 778-2062
713 LAKE SHORE DRIVE
GOLDSBORO, NC 27534
PAY �r� �� ,
TO THE //)
ORDER OF �-
"XJ%Xl
BRANCH BANKING AND TRUST C
GOLD RQR NORTH CAgOLI A 27111
FOR 1
1160000522611' ':053LOLL20:LL232381.580
5226
66-1121531
/ ? 19
l $ Lam/ 0,
�r
DOLLARS

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify thatI own property adjacent to
�1 'm A A V✓ L � �/' Is property
Name
located at O 3 V,41/ S
(Lot, Block, Road, etc.
NERF1
GyL SDI Al in _ Dir'E/l�f�A C'I �TY , N.C.
(Water Body) (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 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.
t/" I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Signature
Iy.G'.A/t1 XWz t-
Name
9/2 �12f S/30
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify thatI own property adjacent to
Name
's property
located at on
(Lot, Block, Road, etc.)
in , N.C.
(Water Body) (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 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.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
7Z
ignature
Name G 7-✓
Phone Number