23139_SUGER, DICK_19990913

CAMA AND DREDGE AND FILL
GENERAL : a 23139-
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
Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETC ` (SCALE:*
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
This permit is subject to compliance wi'ith 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 in�Iermit
ected for compliance.
The applicant certifies by signing this that 1) this pro-
ject is consistent with the local land Iuse plan and all local
ordinances, and 2) a written statement �as 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 Borth Carolina Coastal
Management Program.
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J,
4
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attachments
application fee
applicant's signature
permit officer's signature
issuing date expiration date

1616
ERIC B. ELLIS
NCDL 65047 PH(252)72" 75 66-30/531
205 NOTTINGHAM DR. piste 133
MOREHEAD Cfry, NC 28557 ;kh
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to aA-'5V sC,F— 's
(Name ollProperty Owner)
property located at /�� /d r� fitr���Su ��i✓isa,� ,
(Lot, Block, Road, etc.)
onA "- , , (Town in �t-/-1 v� N.C.
4v(Waterbody) ���
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/boatliftlboathouse 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)
Signature C
1 1\/1
Print or Type Name
as a - I & - 53 lsf�
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATZIFl/BOATHOUSE)
I hereby certify that I own property adjacent to •��,1 's
(Name oY Property Owner)
property located at //c
(Lot, Block, Road, etc.)
on in.c -� s , 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)
Signature
Print or Type Name
9`1
Telephone Number
Date:/S'��