10621_General Permit_19921211

CAMA AND DREDGE AND FIL' VIED
GENERAL
PERMIT EC 1 7 1992 _ �
_ _ 10621 D
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources`an'B1n L"4Jn!itmission a
in an area of environmental concern. pursuant to 15
f Q�ent'
Applicant Name ' � , ) Phone Number
Address L_ l
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity''
_ State
zips
—T
PROJECT DESCRIPTION SKETISH )
Pier (dock) lengthI`
Groin length
\( �+ ij
number
Bulkhead length
max. distance offshore '�- -• "" �__�___ _
Basin, channel dimensions
cubic yards ! r^
Boat ramp dimensions
Other f f _ �� IX Ji
,'i'.
<,'/i < `� = - •� U
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, �. ' "- _
applicant's signature
imprisonment or civil action; and may cause the permit to be-
come null and void. l t ; i
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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
T v pv� t permit officer's signature
issuing date expiration date
attachments
application fee— > /

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