10815_General Permit_19920623

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina
? T° 10815
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC —z
-7
Applicant Name � I - ru Phone Number
Address A-_ �y �� ly—A
�/
City 7reok j/r% �P State /v <11 zip c-,)%g 3 /79/Vt o/ l
�i!A/� -. v a
Project Location (County tat Road, Water Body, etc.) �u "�' ` l�J � rG^ y"- '� P
r v K6 U A 7 OA-'--V SON f
Type of Project Activity
fivi(A_�o ,r.6AVr ro U
PROJECT DESCRIPTION
Pier (dock) length
SKETCH (SCALE: )
n co t
�rp
✓1 LF
! t/ / � � / � gL,'Zk'PeA6
4�P
Groin length.
number
Bulkhead length ffr
max. distance offshore -
Basin, channel dimensions
cubic yards
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.
applicant's signature
permit officer's signature
issuing date n 1 /' expiration date
attachments I (U V (,U q
In issuing this permit the State of North Carolina certifies that , Q o�
this project is consistent with the North Carolina Coastal application fee
Management Program.

MRS. BRUCE HART 2601
LIC.597715 PH. 752-7028
R5, BOX 31 / - Z 3 19
� GREEN 283VILLE, NC 74 !� 66-112
531
j
BB"
M'-""'N6 ANO T-TCOMAN,
GRE ENVILLE. NORTH CAROLINA 27B34
1:0531011211 920323B71I' 2601
V-

ADJACENT RIPARIAN PROPERTY Oh'NER STATEMENT
(FOR A PIER)
I hereby certify that -I own property fadjacent to
c A S r v' cP C< (�"si` 's property
Name
located at , on
(Lot, Block, Road, etc.)
in N.C.
Water Body) (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 must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I 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
FIL,I.ED IN BY INDIVIDUAL PROPOSING DEVEI,OPI+ENT)
si n ture
Name
Zgll )4V
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that -I own ,prope
Name
located at
ty adjacent to
(Lot, Block, Road, etc.)
's property
, on
in
(Water Body) , N.C.
(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 must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I 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 DEYELOPmENT)
Signature
Name
1-ql i - (' s�
Phone Number