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Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.}
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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as authorized by the State of North Caro lin MAY 12 1992
Department of Environment, Health, and Ns,
in an area of environmental concern pursu o A(`
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Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
X
Bulkhead length,_-- //0
'°
0
max. distance offshore
cubic yards
Boat ramp dimensions
Other
N! 10336
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Resources Commission
Phone 46mber
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Stat, y.�'� Zip
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130
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This permit is subject to compliance with this applicatibi f F
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drawing and attached general and specific conditions.
violation of these terms may subject the permittee to .
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applicant's signature
imprisonment or civil action; and may cause the permit to be-
come null and void.
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This permit must be -on the project site and accessible to the
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permit officer's signature
permit officer when 'the projeci'l5 i0pected 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
issuing date expiration date
°
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that
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this project is consistent with the North Carolina Coastal
application fee
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Management Program.