23210_TYSON, JIM_19970803

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CAMA AND DREDGE AND FILL
GENERAL 114'V 2-. 3210
PERMIT
as authorized by the State of North Carolina Ur
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
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
' k•
F
Zip
PROJECT DESCRIPTION SKETCH 7 (SCALE:
Pier (dock) length
Groin length `
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
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 may subject the permittee to a fine,
applicant's signature
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's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- 1
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee `
Management Program.

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ADJACENT RIPA AN PROPERTY OWNER STAIMMENT
(FOR A PIERIUNCOVERED BOAT ,UM P'6 G0*c
y certify that I Own property adjacent to ,
(Name Property caner) s
Property located at /Z�
*az'-'r t, BiocJ4 Road, etc.)
on_ Y
cw�r�ay; `� any/ �,'-Z— ' rr.c.
or may)
He h.s des(lb:4 W Brae, as shown below, the developmtaat Fie .s Proposing at that
location, and, I have l:c� t�f,#,ections to his sal. I un
must be set back a �r' PrOp° did that a Pier/"covered boat lift
���' �n distance of fifteen feet (15') from my area rt,r ,riparian access unless
waived by me.
I dQ -WA W;�'>h t*3 waive the setback requirement.
-- v — I dQ wn7Yr to waive that setback requirement.
DFSC€1MGN /OR DRAWING OF PROPOSED '&,—K 'WAJ?AEENT:
I'o be ,filled in by individad proposing devela"j,,;a)
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Print or Type Name
Telephone Number
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Date:

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AIXFACIENT RIPARIAN PROPERrf COWNIER
SIATUVE
(FOR A PIERIUNCO'T&,.-O jRO 'm fW
CWe—
NT
certify that r own Property ad-
Jacem to
s
e
Ocat-ed at Property Owner)
JOwner)—
Utq Mott, Roue
a� ino r,� ody) N.C.
County)
k, R"� ur C
Y6 has described to me, as shown below, jow '"OPMent he is proposing at that
, and, I have no objections to his propcsal,, D�e
uc wr back a rn�mum dista"r 4"Ide-stand that a piewuncovered h0f, _P of p
V''V me. 4 rn
4 Y area of riparian access unless
49-210A wish to waive the setbatk mq�-.-a
d2 wish to waive that setba,
DES CRnMOIN AND/OR DRAW iNG -------
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Date 4 12-
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