10871_General Permit_19920828

CAMA AND DREDGE AND FILL
GENERAL
Y
PERMIT �?ML Feu com 10871
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 15 NCAC Ii E!
Applicant Name Phone Number t
Address ;i �./ t- K k S! C ~`/`� / "L.
City r , _ StateZip fC
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH ,
Pier (dock) length
Groin length.
number
r
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 ail local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
(SCALE:
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applicant's signature
Avv
! permit officer's signature
k
issuing date expiration date
"
attachments 7/J.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee o e)
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Lot, Block, Road, etc.)
on �L?.e. �� i�Z�4 C��, N.C.
(Waterbody) (Town d/or County)
11
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 �velgpment)
A
i1n �
Print or Type Name
we? -- cfw `7)7/O
Telephone Number

15-800
p()STALMONEY ORDER
y661,0406802 920828 285570 **50*00
PAY TO
ADDRESS
r�Ol
GOD NO. OR
USED FOR
i:00000800 21:
'.AR, MONTH. DAY POST OFFICE
CHECKWRITER
IMPRINT AREA
FRO
ADDRESS
340680 2��'
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