21121_SIRKIN, SCOTT & SUSAN_19981210

r CAMA AND DREDGE AND FILL 14
GENERAL 021,. 21.��--
PERMIT
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 t j
Applicant Name Phone Number= =i
Address
City State Zip
Project Location (County, State Road, Water Body, etc.) x
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
� r
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.
attachments
j applicant's signature
i
permit officer's signature
issuing date expiration date
M
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

4 76 8
COASTAL MARINE CONTRACTORS, INC.
P.O. BOX 12729 PH. 252-638-6407
NEW BERN, NC 28560
DA"
PAY ��AI4
TO THE
ORDER OF
z)
01901 BMT
CC 3'7.5\ SOUTH FRONT STREET
FOP -� f r iV wj�eE zagp 21��-
110000047M30 i:053101L20:5LLOLL26913no
66-112/531
pb
is
DOLLARS ���e,

ADJACENT RIPARIAN PROPERTY OWNER STATEAMNT
(FOR A PIER/AIOORING PILINGS/BOATLIFT/BOATIIOUSE)
I hereby certify that I own property adjacent to soe✓S, rv��(j, `,,u •s
Name of Property Owner)
r
property located at <--
(Lot, Block, Road, etc.)
on d v�� �l� , in 1" G `P! 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 a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRANVI G OF PROPOSED DEVELOPMENT:
(To be filled in by indii•idual proposing de�,elopment)
Print or Type Name
Telephone Number
Date: i '- --?—/L

y ADJACENT RIPARIAN PROPERTY OWNER STATEnTENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATIIOUSE)
I hereby certify that I own property adjacent to S cc, � * 'S ,','!Tia' 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on 11,1vSc , in C 0 , 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 a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------- ---------------------------------------------
�� /vl '�t�'
Signature
Print or Type Name
63�- -sus
Telephone Number
Date: