24375_QUARLES, RICHARD_19991229

CAMA and DREDGE AND FILL
G E N E R A L 'ad 24315
PERMIT
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
Applicant Name Phone Number
Address
City State Z i p
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
I HIS PerffIR IS SUUJeCI LU LOITIPI1df1(_C wllll MIS dPPII(_dUUII, Slle UfdWIII9
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and attached general and specific conditions. Any violation of these terms
applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
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
have no objections to the proposed work.
attachments
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
application fee

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H&z* of Individual Applying For Permit:9/ lt'f
Addross Of Property;
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(i.o ee rest or oa $ My & Coun y )
I hereby certify -that Z own property adjacent to , the above -
referenced propgrty. The individual applyinq for this permit has
described to as as shown on the attached drawing the development
they arm, proposinq. A "scriptiga or drawing, with dix+rnsions,
shoal T s ov ided with this latter.
i have no objections %o this proposal.
t�►� ivy-_atc�r�
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1 und*rs ,and that a pier, dock, mooring pilings, breakwater, boat
hcuse, lift ®r sandbags gust be set back a minimum distanc6 of 15'
from my area of riparian access unless waived by me. (if you wish
to waive the setback, you MMt initial the apprcpriate blank
below.)
a
!' do wish to waive the 15aretback r quirament.
dnot wish to waive,. "e 1.3 s setback requirement.
ireto s e p
r nt aye
• ap me Number With Area C004
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MELFCRD MARINE t,:ONSf.
P. 0. BOX 3556
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Name Cf Individusl Applying For Pa=it$
Address Of prcpertyt
Mg -'or —Woad, City (i Coup y)
I hereby certify 4that I own property. adjacent to the above"
referenced propgrty. The individual applying for this pormit has
described to to as shown on the attached drawing the dsvelopmont
they are proposing. A description or drawing, with d tensions,
should be provided with this letter.
have no objections to this proposal.
I understand that a pier, dock, roorinq VLlings4 breakwater, boat
house, lift or sandbaqs must be ast 'tack a tainimum distance of 15'
from my area of riparian- ••sa onl�nitiaSss waived
tha yapprr�priat you
blank
to waive the aatbuck, youm1i�.t
below.}
sh to waive the 151setiback requirement.
sh to waive the 15:amthack rsquirsma3nt.
aura ate Ar
print -Hand Ad
t ep cn• Num er With Area coo*

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MEDFORD MARINE CONST.
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WW KW He 285643M
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