21442_PYSHER, RAY_19990517

O
CAMA AND DREDGE AND FILL'
GENERAL
PFR&AIT
Applicant Name Nhone Number
Address
City
Y
d general and specific conditions. Any
�
applicant
on the project site and accessible to the
s by signing this permit that 1) this
work. attachments _
ty, State Road, Water Body, etc.)
TION SKETCH
s
to compliance with this application, site
ms may subject the permittee to a fine,
permit
the project is inspected for compliance.
h the local land use plan and all local
written statement has been obtained from
certifying that they have no
the State of North Carolina certifies that
stent with the North Carolina Coastal application fee
Project Location (Coun
Type of Project Activit
PROJECT DESCRIP
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimension
cubic yards
Boat ramp dimensions
Other
State
r
Zip
(SCALE:
pro -
The
This permit is subject
drawing and attache
violation of these ter
imprisonment or civil action; and may cause the permit to be- 's signature
come null and void.
This permit must be officer's signature
permit officer when
The applicant certifie
ject is consistent wit
ordinances, and 2) a
adjacent riparian landowners
objections to the proposed
In issuing this permit
this project is consi
Management Program.
issuing date
expiration date

DEREK S. SMITH
NC 7836496 PH 919-247-4428 1540
107 HAWTHORNE DR
PINE KNOLL SHORES, NC 28512 66-152/531
DATE
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TACHOVU
Wachovia Bank of North Carolina, A. {
Morehead City, NC 28557 y�
FOR S k Z 1'(J/iti1�
-1:05310L5241: 546E LL32LL540
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DOLLARS � �� lee��,ee
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I hereby certify that I own property adjacent to "i `� y' e' ,------ 's
e Property Owner)
property located at � �� .� �'� ��`� � �
(Lot, lock, Road, etc.)
9� � , N.C.
ater o y) (Town and/or County
—P
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)
poc �
el Jo,✓�s
Signature ,
�/ f cm-i ' Y� 71 Print or Type Name
Telephone Number
Date: ��=9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 7COt y - 's
ame 61f Property Owner)
property located at
(Lot, )
on �� �2 �� in
(Waterbody)
Road, etc.)
�'--° ` ` °�( ree e , N. C.
(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)
12r
PrOA
NO
Si,,na XCI-VAI-VaAl
3a v an /j'l, de/le M `/
Print or Type Name
�so2-A2�/D- 08t,0
Telephone Number
Date:
Cep