HomeMy WebLinkAbout28865_GARDNER, JACK_20011114CAMA and DREDGE AND FILL
G E N E R A L
�t a
PERM I T
as authorized by the State of North Carolina ; r,�!
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
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Applicant Name Phone Number
Address
City State l Zip
Project Location (County, State Road, Water Body, etc.)
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Type of Project Activity'n
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PROJECT DESCRIPTION SKETCH 1''
Pier (dock) Length T
Groin Length
number } `
Bulkhead Length
max. distance offshore
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Basin, channel dimensions
cubic yards
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Boat ramp dimensions
Other
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This permit is subject to compliance with this application, site drawing
and attached general and specific conditions. Any violation of these terms applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and n
may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit of- permit officer's signature
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they I '
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project Tf : L1r 6
is consistent with the North Carolina Coastal Management Program. application fee
JACK A. GARDNER
OR ROSAMOND B. GARDNER
324 Springlake Blvd. 941-655-2553
Sebring, FL 33870
DATE
3383
63-751 /631
BRANCH 00895
PAY TO � (L - b �- & �7 I /� •-
ORDEERR OOF F _ / - F
fsriG� °ti�GU'n� �01� — TM .K
First Union National Bank Benefit Banking®
F�N Sebring, Florida
'7 R/7 063107513
FOR
1:063L07SL31:LL89S3 8LLL7 Ila 3383
I Initl ANI1
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
ti ■ Print your name and address on the reverse
jj so that, we can return the card to you.
1 ■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
6V",. ��-L-6
A. Received by (Please Print Clearly) B. Date
11_
C. Signature
y�
' l l y �,( ❑ Agent
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DA r // d14 0 0a,/ ❑ Addressee
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
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3. Service Type i
1
✓ 1
rCertified Mail ❑ Express Mail
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❑ Registered ❑ Return Receipt for Merchandise
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❑ Insured Mail ❑ C.O.D.
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4. Restricted Delivery? (Extra Fee) ❑ Yes
j 2. Article Number (Copy from service label) s�
iPS Form 3811, July 1999
Domestic Return Receipt 102595.00-M-0952
UNITED STATES POSTAL SERVICE
• Sender: Please print lQgrname, addre�$, and ZIP+4 in
wANS �d/Ip h 2. g f-
First -Class Mail .
Postage & Fees Paid
USPS
Permit No. G-10
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m
Fu
mPostage
$
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Certified Fee
Return Receipt Fee
(Endorsement Required)
0
Restricted Delivery Fee
'
0
(Endorsement Required)
O
Total Postage & Fees
Postmark
Here Z
\� Ci
Recipient' Name (Please Print Clearly) (to be completed by matter)
m BA o?8*f A4 - ¢ /N
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� Street, A t. No.: o�rpPO BNo.
-----------------------------
Catty State, ZIP�4�p J(� n � � rp
� I V 11�.DiA�.i �0��� �i • C_ cJ J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to .J go le— ,W, ��/,vo,� 's
(Name of Property Owner)
property located at
Block, Road, etc.)
on $o c u-� �aGI�Y , in�� 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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back s1 minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
VA�" I do not wish to waive the setback requirement.
I dD wish to waive that setback requirement.
-----------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Print or Type Name
606) (0q(0- 0q'��
Telephone Number
Date: 69-1 ' c'J a000