10896_General Permit_19920921

CAMA AND DREDGE AND FILL
GENERAL
PERMIT � 9 10696
as authorized by the State of North Carolina
,Department of Environmenty�Health, and Natural Resources and the Coastal Resources C mmission
in an aC!'
area of environmental concern pursuant to 15 NCAC 7 tl // '�"/ "`�' / 3C1 �
Applicant Name
Address
City
Project Location Cownty,
pe of Project Activity
a c K 4 tt-
tate Road, Water Body, etc.)
PROJECT DESCRIPTION
Pier (dock) length
Groin length
number
Bulkhead length
I;—
y
Max. distance offshore
Basin, channel dimensions
cu4ic yards
Boat ramp dimensions
Other
SKETCH��
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.
Phone Number_, /`/ - -Y57/ - c� 1/ 4—
State C
I
a/',/xra"cv,
i
Zip /
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(SCALE
- /' f v applicant's signature
permit officer's signature
issuing date expiration date
attachments . /� (-A r ,1/ ll r' /` 6, Y 1;ne,)
In issuing this permit the State of North Carolina certifies that AY
this project is consistent with the North Carolina Coastal application f
Management Program. ��

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Sep 21,92 10 : 02 P.01
ADJACENT RIPARIAN PROPERTY OWNER STATEMM
I hereby certify that I own property adjacent to
<—) '74 /� i
's property located at
56-
1 0J
Lot, Blaa , Road, et
J r r � f� � N.C. lbod
inn C.(J�Abt�uL (_� I r
on {ovate X down and/or County
He has described to me, as shown bol.ow, the development he is
proposing at that location, arLd, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVET,O MEN
(To be fJLlle4 In by Individualpropas ng development)
Pro P r ST6 or�h.
F I
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Signature
Pr I n+- nr T'trne Nana

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
t
's property located at
Name of Property Owner)
i9Lvl2vm
(Lot, BlocId, Road, etc.)
on ea �% �G���'1.�,, in .. `7- _. N.C.
(Wa body) (TowiY 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
(To be filled in by individual proposin
PMENT:
gment)
- gnature
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Print or Type Name
'?%? o?a&-&�a� 2
Telephone Number
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