10972_General Permit_19921217

Applicant Name
Address
City
Project Location
r
CAMA AND DREDGE AND FILL
GENERAL
PERMIT _ fl0972
�
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
�-� / `�7 `� �' �'r�,P/►. Phone Number
nty, State Road, Water Body, etc.)
Type of Project Activity S 00
State zip W�,
PROJECT DESCRIPTION
SKETCH GG �V
(SCALE:
Pier (dock) length
,p_ a
Groin length.
number
i
Bulkhead length
/�t,
f
�!
i
f .�
^4 /
max. distance offshore
/
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
.I
i nis permit is suolect to compliance witn tnis 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.
f
j applicant's signature
vpermit officer's signature
l0- /-) - 9; 3-)7- �;'3
issuing date expiration date
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attachments - / C c 7 ' / l / () 0
In issuing this permit the State of North Carolina certifies that [7
this project is consistent with the North Carolina Coastal apprication fee- '' _/ O, �/y
Management Program.

EROSION CONTROL SPECIALISTS 470
ATLANTIC BEACH CAUSEWAY
P O BOX 3355 919-726-2191 66 30t531
ATLANTIC BEACH, NC 28512 /
19 �y
ORDE^ROFE N e I $ SQ
vD `�
FI ITIZENS BANK DOLLARS
First -Citizens Bank & Trust Company 133
Atlantic Beach, N.C. 28515 `A
FOR
A:053100300I: L3 L 214B53511' 0470

ADJACENT RI"ARIAN PROPERTY OWN': R STATEMENT
I hereby certify r.hat I own property adjacent to
N C—rL �4x�k _ s property located at
(Name of Property owner)
c.0 - ��A_
(.,ot, Block, Road, et )
on t' C ? ��IJr4`e _�- in 01XI, F,HO C L T 4Op 4l � , N.C.
(Waterbody) (Town. and/or County)
He has described to mu, as shown below, t.-ie development he is
proposing at that locazAon, and, I have r,:) objections to his
proposal.
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DESCRIPTION MID "OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�oP_;.tE-E �iL°�� LH�ui.ICL To SAL.:L LS-_ A�
.i
`ro alai. ar, ,
Signatute Mary 1.UKanyha, Mayor
Town of Pine Knoll Shores
Print or Type Name
247-4353
Telex. -_�r.one Number

ADJACENT _`:IPARIAN PROPERTY CNiNER STATEMENT
I hereby certif_that I own proper:-y adjacent to
/I N C— f L ' s property located at
(Name
of Property Owner)
(Lot, Block, Road,. etc.)
�/XU€ l�N,9L C. S'i- 0AC-AC - � N.C.
on �-L' e� .�S �!-4��4N�/� � In '
(Waterbody) (Town and/or County)
He has described to ine, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
-------------------- -----------------------------------------
DESCRIPTION AND/OR DRAWING OF PPOPOSED DEVELOPMENT:
(To be filled :in by individual proposing development)
E SL A knE/" J F 1�-a C) L i IJt4---- r ii . D F 1�)ETE.2 r c>e"Y �
roe- Sio 2c;7q j,e2v
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gnature
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Print or Type Name
Telcohone Number

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