11014_General Permit_19930723

C4N-
CAMA AND DREDGE AND FILL
GENERAL S-v� r M-P 11014
PERMIT 4,0/
Applicant Name
Address _
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 pursuant to 15 NCAC ` `
concern
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
State Zip
PROJECT DESCRIPTION SKETCH C ,�� �{ (SCALE:
Pier (dock) length `% _
- - i--- i
Groin length
' T I n
number
Bulkhead length LJ
}
I
max. distance offshore �( I �
I � �
Basin, channel dimensions U+
cubic yards i -i
— -� —�
— I i e
Boat ramp dimensions
Other
IT
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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 the4roje-q site and accessible to the
permit officer when the pr*rt 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
Management Program.
application fee
J
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 the4roje-q site and accessible to the
permit officer when the pr*rt 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
Management Program.
application fee

ADJACENT RIPARIAN PROPERTY ()W ER STATEI1-ENT
(FOR A PIER)
I hereby certify that I own property adjacent to
7
Name —oz 's property
located at
(Lot, B16ck, Roadl etc.) ' on
(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.
1� I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (To BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELppyENT)
Vl -
signatu e
Name
22-4,-- F 9
Phone Number

;kDJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
Name s property
located at
(Lot, Block, Road, etc. )
(wat Bo y) d2 �� �.
(Town and/or County)
, on
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. 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)
natur
Name
- 7 L (�- _4�79 7
Phone Number '