21432_YODER, JAMES AND JUDY_19990602

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Applicant Name
Address
CAMA AND DREDGE AND FILL
GENERAL
PERMIT f ��
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
Phone Number
City
Project Location (County, State Road, Water Body, etc.) -
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
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.
State
Zip
(SCALE:
applicant's signature
:'
permit officer's signature
issuing date expiration date
i I
attachments l--i
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

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SERIAL NUMBER
YEAR MONTH DAY POST OFFICE
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A.)JACENT RIPARIAN PROPERTY O'T►,�rNER STATEN ElENTfi��,
T hereby certify that I own property aljacent to _ _
V s
(�Yame of Prope Owner)
property located at
(Lot., Block, 1moad, etc,,) ��---'
on
(Waterbody) Jcv,-n and/or County), N C.
He has described to me as shown below, C.It- Of--,' elopment he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAW.TN",-,, � OF PROPOSED DEVELOP MNvT
(To be filled in by oposing development)
N
i Iv
SigLture
Print or Type Name
Telephone Numbe:
Date:

-JACENT RIPARIAN PROPERTY OWNER STA �
I hereby certify that I own prope,-ty adjacent to
(Name� Hof operty Owner)
property located at_
(Lot, Block, Road, etc.)
on in - N, C.
(K'aterbody) (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 b, his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP
(To he filled in by individual proposing development)
Y
VFW"'�}�JE�j//�!J�_
Sianat
Print or Type Name
ITelephone Number
Date:
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