10987_General Permit_19930212

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CAMA AND DREDGE AND FILL
GENERAL (�l�
PERMIT *TC110987
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources an the Coastal ources Commission
in an area of environmental concern pursuant to 15 NCAC 7 / es
/ I F r'
Applicant Name ! !
Address
City 11,1- 4, State
Pr�ject Location (Counjy, State Road, Water Body, etc.)''
Type of Prgjecy, Activity
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
'JAId'q_-
Phone Number
zip
SKETCH L �'�'/ l A 4 o 4 (SCALE:
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.
1
issuing date
attachments / V C 1 r
;I
applicant's signature
permit officer's signature
S"�.?- / 3
expiration date
In issuing this permit the State of North Carolina certifies that d (-r - /
this project is consistent with the North Carolina Coastal application fee YYY��, b
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER)
I hereby certify that -I own property adjacent to
' s property
Name
1 C
located at on
(Lot, Block, Road, etc.).
uz -i �n � r l� 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 (151) from my area of riparian access.
unless waived by me.
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 INDMDUAL PROPOSING DEVELOPMENT)
k
Signature
Name
Phone Number

I h
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR -A PIER)
certify that•I own property adjacent to
_� >>
/ ov
's property
Name �.
located at _ s % ;;� �► 6' 1 on
(Lot, Block, Road, etc.).
1
� (1r c-R C rry(c in NF, J 13 F 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 (151) from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
Q (p�;s I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDMDUAL PROPOSING DEVELOPMENT)
S' nat re
Name
6Ssd
Phone Number

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