10876_General Permit_19920915

I
CAMA AND DREDGE AND FILL C+= C
_GENERAL AN �d
PERMIT 4r _ a
876
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
PROJECT DESCRIPTION SKETCHY
Pier (bock) length
Groin length
number
Bulkhead length
max. dista ce off ore
Basin, channel dimensions
{p hf 1
cubic yards
t
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 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.
(SCALE: )
�+ applicant's signature
c� permit officer's signature
1 ri o7 f 4 Al
issuing dpt� expiration date
ll ®0
attachments . :2 L 2 Q 0
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee_ ro. o
Management Program.

J. M. FORDHAM
227 E. WALNUT STREET
GOLDSBORO, NC 275W
TO THEPAY p ` '
ORDER OF 'v`
1�0E7-
2634 s;
66-112
C'I — I S �19 Cl D, sat
I $ Slj.Oo
' 1 OLLARS A
Bl�l I 1
MAMCN fANMMN AMp TNYfTCOMIAMY _
O DSBORO. NORTH CAROUNA 27530
FOR1nSn��
N 1120000 2634112 40 5 3 LO L 12 0: L 1230 20 5B Lsul
W -.
u

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
T M ForcQharn
(Name of Property Owner)
's property located at
(Lot, Block, Road, etc.)
on in Me-Vr\'moh , N.C.
(Water ody (Town and/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.
R�
p rQ
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
eft I , M-, L o Crt"al
S nature
Print or Type Name
( IWA) � 3) I - L OD
Telephone Number
�i AUG 2 0 1992

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
-S. M . Fpr((m Is property located at
(Name of Property Owner)
Mai . \CO(D Wa\a- -
(Lot, Block, Road, etc.)
on �U�lp'\r� �in Me.Vr�moh , N.C.
(waterboody (Town and/or County)
It
shown bc- t1hc development he is
He has described to me, as sa.vw,i �,•:-1o.v, ••-- -
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOFMk:NT:
(To be filled in by individual proposing development)
}" '+���p T� 1
S nature
-I. K' FUrdV\4w\
Print or Type Name
(CW-0 �?S �- l Oil
Telephone Number
Q,
rFMr"^
AU6 2 Q 1992
i
6�1�1UC7uC.
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