23283_CRISP, MR & MRS_19990929

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Applicant Name "
Address
City
Project Location (Coun
CAMA AND DREDGE AND FILL a 60
GENERAL NY 23283-�'�
PERMIT
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 15A NCAC 911 all
Type of Project Activity
Phone Number
State /L1C zip 4.
State Road, Water Body, etc.)
PROJECT DESCRIPTION j SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions 2
Other
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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.
applicant's signature
permit officer's signature
9 Zg. 99 16-?C,- �9
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee_ U,41 V F0
Management Program.

SEP-28-99 TUE 9:19 AM EASTERN ORTHOPAEDIC GRPQ FAX NO.
04/27/99 15:24 FAQ 9527284182 T D ECRE
19197571914 P. 2
t.
To Whom It May Concern
C'gL5-p
T. M RW r wrrr W_ m
�p0r,
I tN CAVox � crtv. .+nu 2�s7
give peMssicm t ��to
act as agent in my ha, f cafataix tzg a LAMA GenwiJ Permit to place sandbags as
temporary eFg�n control structure m , of Property IOC8 ed
a
at 3 -Y � � �., in the towns of
I lmve read the specific conditions in l SA NCAC 7H. 1700 and understand that by
receivimg such a pernut, I will be res l"ok for the removal of remnants of all or
portions of any damaged sandbags, and that the sandbags may remain in place for
up to two / fiw years after the date of permit approval. Circe the temporary erosions
control structure (sandbags) is determined to be unnecessary due to the rehacatioa or
removal of the house, the bags anusv, be removed within 30 days.
I also understand that the removal of the sadbnp shall not be required if'they are
covered by dunes with vegetation sufficient to be considered stable and natural two
yeas from permit alrt wal date.
Authorized Signature Date

ADJACLNI' 1ZIPARI.AN I31101'I:IZTY U«'NU IZ STA'1TEAR"Ni'
(FOR A PII R/AIOORING PILINGS/ROA'1'I.II I'/ROA MOUSE)
I hereby certify that I own property adjacent tokA5M--b-(—Cw s
(Na►ne of Property Owner)
property located at-'�.J 'r6l-LQZ(S� ItL1 _
(Lot, Block, Road, etc.)
Oil - C,.11�-C�Q P'l in 9i 0 1 ` �2 ��Qr� N.
OVaterbody) (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/mooring
piliiigs/boatlifUboathouse must beset back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do_ riot wish to waive the setback requirement.
I do wish to waive that setback requirement.
DFSCRIIYi'ION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(7o be filled in by individual proposing development)
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ignatur-
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Print or "I'ylk Name
25, Z((7 5og7
Telephone Number
,q
Date: - - /

Sep-23-99 03:31P 919 580 0988 P.02
Sep.23 '99 ] :21 FI -'TECH PKS FAX 91924?612S P.
ADJACENT IUPARUN PROPERIT OWNER STATEI'IEN I*
(MR 4 PIERIAMORING PILING.5/BOA71.ln'IPOATIIOVSr•)
I hereby certify that I own property adjacent to ��-t so*� (_:X"' VSP .s
Z
nte of Property Owner)
propcfly Ic►CalccialLeg ,r' °3 4- — Ap- r,,,.tG .
j (1..Ut, Mock, (toatd,, etc.)
on in N.C.
(Waterbody) (Town atttl/vr County
He has described to me, as shown below, the development fie is proposing at that
)ovation, and, 1 have no objections to his proposal. 1 understa,id that a pier/mooring
pilings/boattift/bvaftuse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
1 do nal wish to waive the setback requirement.
(` i Slo wish to waive that setback requirement.
D£SCRI TJON ANDIOR DRAWING OF PROPOSED DEVELOPMENT -
(To be filled in by individual proposing derelopmew)
Y
AA -rA PA Wr K Y
---------...........--.----------------------�c.J=KFZY ---------------------------------------------------
III&
Signature
I'rint or l'yhc Name
_Q{4 ?3t- 2S'I.
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