23599_EVANS, ROBERT_19991025

C AMA and DREDGE AND FILL All e 46
Ob
--� G E N E R A L-'
P E R M I T
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 0
Applicant Name � t e'° tips'✓ Phone Number��-
Address
City [a _ r! State Zip
Project Location (County, State Road, Water Body, etc.) r�C of
Type of Project Activity /r..;�-�.f. c."� r� ✓�:.d .G' .fi ,�
This permit is subject to compliance with this application, site drawing
and attached general and specific conditions. Any violation of these terms
i applicants signature
may subject the permittee to a fine, imprisonment or civil action; and
! j"
may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit of-
permit officer's signature
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local
issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they
%fit'•` v
have no objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that this project
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is consistent with the North Carolina Coastal Management Program.
application fee

R-QUERT J.EVANS_ 2736
BARBARQ_L EVANS 66-152/531 CC
DR
PIN KNOLL HO
PINE KNOLL SHORES, NC 28512 Date
Pay To The
Order Of
Dullrrrc � �;S,IG o� �.,w
Wachovia Bank, N.A.
Ili- K-11 Sh—, NC 2855T
i:053LOL5291: 5462 197519 2

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'k
I hereby certify that I own property adjacent to
s property
located at qs a,� �C E�� V'-z I � , on
-r (Lot, Block, Road, etc.)
l3oC(U O v�cl� i nN.C.
— ,
(Water Body) (Town an County)
He has described to me as indicated below the development
he is proposing at that location and I'.have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet.
(15') from my area of riparian access unless waived by me.
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.)
I q �
!a 6l 4aSUIZ1149 l2'e4-, X C�6k0fOV 109 2/y' 'DEr�'rb}
30 cu yns r9\f�c �Eou�f�,
z
J
Date
270'
�J
-'A N
/r/'? SEgwq«
Signa-ure
tivI�it�75�r J
Print Name
Phone Number

`� SG - Sc/� �r 2

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I ow\ property adjacent to
s property
located at (qr on
T (Lot, Block, Ro d, etc.)
+mil/ UC o uo
ACCES►r4\�
S' elX1E L in _ �� N.C.
(Water Body) (Town and/or County)
He has described to me ,as indicate below the development
he is proposing at -that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum dista\nce of fifteen feet
(15') from my area of riparian access unless waived by me.
Y do not wish to waive that setback requir1ement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(.To be filled in by individual proposing development.)
�l�iasu/ei�t9 l2 '�, x 3bf
%I--/i—'':
Date
.f2eW o v I yy 2-
3 o &
V)
270'
�Q
&LS,laq '3CAwA
I
Signature
Print Na e
hone Plumber