10954_General Permit_19921022

Applicant Name _
Address�z
City, �t�19
Project Location
Type of Project Activi
CAMA AND DREDGE AND FILL
GENERAL
PERMIT rya 10954
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
ty, State Road, Water Body, etc.)
PROJECT DESCRIPTION
Pier (dock) length
n /.
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
a
SKETCH
z
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.
Phone Number % 2 % — 1' i
State � - C
Zip,,,
S
1
/ > (SCALE:
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a
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applicant's signature
n /
/ permit officer's signature
issuing date expiration date
attachments . /// Z /� c
In issuing this permit the State of North Carolina certifies that 0�
this project is consistent with the North Carolina Coastal application fee r
Management Program.

EROSION CONTROL SPECIALISTS
ATLANTIC BEACH CAUSEWAY P O BOX 3355 919-726-2191 415
ATLANTIC BEACH, NC 28512
PAY66-30/331
ORDER OF E 19 ���
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FIR CITIZENS g K
First•Citizens Bank & Trusi CoAN ` DOLLARS
Atlantic Beach, N.C. 2mpany
CO 133
FOR 61
531003001:131214853511s 041
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ADJACENT RIPARIAN PROPERTY 0'4NER STATEMENT
I hereby certify that I own proper. ,,-_y adjacent to
od0_ &I4 ' 's property located at
(Name of Property Owne ) .
2 ©014Z9 (Lot, Block, Road, etc.)'
on ,4� ASS lrl-)Qh(H1C=�� in k gl/ Q4LL_ �f i �, N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that lccation, and, I have no objections to his
proposal) PROV, d"It the--+ C6►75`Ef21 art 0 r7 f-ede-R�L_
.a'7'J)TE atzc� �ocq L _ ove�2�rn�s12`: _1=�'r�'_ -------------- "- i(lo
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DESCRIPTION AND/OR DRAWING OF P1,.0POSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
C - CS C," LC7
Prii t or Type Name
Telex one Number

ADJACENT P.IPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(N`ame of Property Ownet )
(Lot, Block, Road, etc.)
on !�� �S AA41d4=C • in `i"dE �N0/-1--
L�N.C.
(Waterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
��I�STQUG�T 101� 04 - I-Pli1 e- 2&�4mc-L
Or-
1 0v ` L /,c/�'i(.� f EL t TO 7 A L
Signature
'5; /V ya G C. dl 1 c rl
Prirt or Type Name
-2,�4 `i A- 61i'%^P---
Telephone Number

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