21197_SALISBURY, CHARLES VAN_19990222

CAMA AND DREDGE AND FILL
GENERAL 02. 197
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.)�-
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Type of Project Activity` 1.%' `w4 "max ry�J�\l� >Tr'i- k,— -rrc)
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PROJECT DESCRIPTION SKETCH _. C,_ ;>T A (SCALE: t--a )
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 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.
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applicant's signature
permit officer's signature
issuing date
expiration date
attachments �4 lw
It
application fee

LIBERTY
LINDA OR WAVERLY D. SHORE
HER CDL 4789 MARINE CONST. Z 2 Z C' 6 2 8 6
HER NCDL 4789098 HIS 3266479
PH. 919-745-7992
P.O. BOX 163, DIXON RD. 66-779612531
VANDEfMERE, NC 28587
PAY TO THE
U
aa E
ORDER OF
c
MEMO
1: 2 5 3 17 79681: 0017906,11 6 286

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1'/1"I is ���;' `>f// '>
(Name of Property Owner)
17
property located at �-
9
(Lot, Block, Road, etc.)
on Sf/�'/� C: (,/ % , in ✓J'�i l- �� , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filLd in by individual proposing development)
Signature //
/fo�eRr ��E� 7z�,,11
Print or Type Name
Z .SZ — Z ` q —/16�'D
Telephone Number
Date: 212 - / s
-29-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tois
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on d / t.` �' , in l%/'1 L r G U , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
,') U &ri� /�'OGeS
—29—
Signa re
Print or Type Name
Telephone Number
Date: