23147_SCHOONDERWOERD, PETE_19990720

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CAMA AND DREDGE AND FILL
GENERAL IN? 23147 - c cell
PERMIT cz_,, _11_5�
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 15A NCAC
Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length
Groin length
number —
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
40
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CIF
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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 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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
applicant-s signature
permit officer's signature
issuing date expiration date
attachments (2 ^ LV
application fee

UNITEDST/�T�S POSTAL
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SERIAL NUMBER VFna
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PAY TO
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CHECKWRITER
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AHn AND CENTS
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C.O.D. NO. OR
USED FOR
f ' �-:ltNEGOTIABLE ONLY IN THE/Li :AND POSSESSIU S
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"JJACENT EIPARIAN pR0,�,.vFA:1, y OWE STATENIF'V'I'
(FOR A PdERIUNC, VERED BOAT lipl)
I hereby certify that I own property ad; cent to
(Name Owner'
property located at 3�`D ` l�
(Lot, Block, Road, etc.)
on
s . in NT,.C.
('(i'aterbody) own and/or CountY )
He has described to me, as shown bey �w, the development he is
roposing at that
location, and, I have no objections to his propo. al. I undrrstand that a Piet/uncovered boat lift
must be set back a minimum distance of fifteen .fart (15') from my area of riparian access unless
waived by me.
I moo& wish to waive the setback, requirement.
I dQ wish to waive that setback requil ment.
DESCREMON; AND/OR DRAWING OF PROPOSED DEVELUPMENT, w_
(To be filled in by individun±Proposing development) .
�X�ST`y
JUL 1 9 1999
U
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i0 nt or Type Name
', ephone Number

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