10851_General Permit_19920803

as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Com lion
in an area of environmental concern pursuant to 15 NCAC / �-J J r.
Applicant ,N�a•�me v 4`,^,7'-r_� Phone Number _ E f - � 3 L - 2-
Address /2 i
City w,- k4Go
Project Locatjj'on (County, State Road, Water Body, etc.)
of Projecf'Activity
PROJECT DESCRIPTION SK -I H�A�
Pier (dock) length G S
Groin length.
number
Bulkthea length
max. distance offshore
i
Basin, channel dimensions
30 ,zXi-2'4-
cubic yards
92
Boat ramp dime sions
Other
This permit is subject to compliance with this aoolication•_j.te
drawing and attached general and s i is 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„p, o? ect 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.
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applicant's signature
permit officer's signature
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issuing date expiration date
attachments
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In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fees
Management Program.

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PAY TO
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ADJAC
RIPARIAN PROPF
(FOR A PIER
I hereby certify that -I own property adjacent to
4�1�/ Is property
Name
located at � a on
(Lot, Block, Road, etc.) �-
` (� in�� s� �d� , N . C .
ater ody) (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. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
✓ I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
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He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (15') from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
--��I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN By INDIVIDUAL PROPOSING DEyELOPIENT)
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