10973_General Permit_19921217

CAMA AND DREDGE AND FILL
GENERAL
PERMIT � -09 7 3
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Reso and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC ? %/ /% 4
Applicant Name Y
Address
City
Projec
Type of Pr
County, State Road, Water Body, etc.)
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.
6
Phone Number V 1 % - h /9
applicant's signature
V�
permit officer's signature
9;� -3-/,�-l-?
issuing date expiration date
attachments _A C 4 ( 7 P P ✓' 0
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee o+ 0 `' 4 itr=— = 11 / .13 r3i

PAY
TO THE
ORDER OF
Wachovia Bank of North Carolina, N.A.
Morehead City, NC 28557
FOR C/th A- e&Lk,
ll@ 00 1 It 3 2,10 1:05310L5291: L 02It3800
01132
66-152/531
009
19�
SO-00
DOLLARS

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Name of Property owner
(Lot, Block, Road, etc.
on in 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)
So
ignature l L 7
Print or Type Name
Telephone Number

ADJACENT RIPARIAN PROPERTY Ct,MER STATEMENT
I hereby certify that I own property adjacent to
B o` K erg(/./ rJ-
(Name of Property owner)
's property located at
© 4- 1E : i)'r— ry cr
(Lot, Block, Road, etc.)
p� S'bv Nla
on �' �G1�N�/-- in{�,{L<
(Waterbody) (To -Am and/or County)
He has described to me, as shown below, the development he is
proposing at that lcc-ation, and, I have no objections to his
proposal.
DESCRIPTION TND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
N.C.
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AS 4?6�S 6d
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L " o 4ZN�l�
Sia ,attire
Prirt or Type Name
Tel. -phone Number

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