11789_HOLLER, LARRY_19930603

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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 t C al R so missionN�,�,;
in an area of environmental concern pursuant to 15 NCAC %i�, i f r
i / % r
Applicant Name Z �rfib�%� y'/'C��� J �/� Phone �er,�
Address J -�j /i� 17
City % ��/f. <� State Zip ;
Project Lqc- tion (County, State Ro d : Water Body, etc.)
Type of oject Acti i Y 7
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length
ngth
Groin length
number
Bulkhead length
'WInax. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
i'
/ y
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- applicant's signature
come null and void.
This permit must be on the project site and accessible to`e permit officer's signature
permit officer when the project is inspected for compliance.
applicant certifies by signing this permit that 1) this pro -
is consistent with the local land use plan and all local issuing date expiration date
o finances, and 2) a written statement has been obtained from /
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
ten) /
In issuing this permit the State of North Carolina certifies that --� /{'�
this project is consistent with the North Carolina Coastal application fee
. ::�2
Management Program. `—

LARRY D. HOLLER NCDL 1669937 5381
SHARON Y. HOLLER NCDL 3488364
8350 HOLLER FARM RD 66.30/531
CLEMMONS, NC 27012 / 19
PAYTOTHE A�Allvk I �
OR/DDERROOF
Z N/IU0 DOLLARS
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FIRST CITIZENS BANK
First-Citlzens Bank & Trust Company 463
Winston eem,,/N.CC�. 227104
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06-07-1993 06:55AM FROM HOLIDAY INN TO 19192473330 P.01
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140 As Clemm ms Exit - P0. Box 926 • C rnnTo.,g_ NC Z7012.919 766.412 t

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