11897_HILL, CHARLES_19930708

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CAMA AND DREDGE AND FILL
GENERAL -,d Ne. ev A189
PERMIT
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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 %
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
State
Phone Number
Zip
PROJECT DESCRIPTION
Pier (dock) length -
SKETCH
(SCALE:
f p
�' !
4__.._
Y T
i I --
)
Groin length
number
Bulkhead length77
(
^I
max. distance offshore
Basin, channel dimensions
cubic yards
I
i
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 fee
Management Program.

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47946696851 930706 285570 *.*5r'*o0
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
t
is property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
on �
► 1 ,���e
(Wa rbody) n(Town a6d/or County) 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by indiv10 idual proposing development)
/_C'r- ICI LV/ /? I. / /c hi
�06-'Vi
Print or Type Name
`72-co -4- 4-
Telephone Number

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A J
I hereby certify that I own property adjacent to
Is property
Name
located at
WJ i
, on
(Lot, Block, Road, -etc )
�-C N. C.
(Water Body) (Town an,/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
unless waived by me.
AE:�i a n access
etback requirement .
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Signature ,
Name
Phon6 Number

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