10810_General Permit_19920710

CAMA AND DREDGE AND FILL
GENERAL
PERMIT NO 10810
as authorized by the State of North Carolina J.
Department of Environment, Health, and Natural Resources and the Cost I Resources Commission
in an area of environmental concern pursuant to 15 NCAC i
Applicant Name _ (��� Del eo Ly,4i
Address
City __ _r State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity 'ter i
PROJECT DESCRIPTION J SKETCHY,
Pier (dock) length
Phone Number "9 r, ` �ry
!
zip.
,
Groin length
number
Bulkhead length
max. distance offshore /
Basin, channel dimensions
cabic yards
r ,
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
! permit officer's signature
r issuieg date / expiration date
attachments '
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
1
application fee , � �-

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0286
EROSION CONTROL SPECIALISTS
ATLANTIC BEACH CAUSEWAY
919-726-2191
86-30/5
P.O. BOX 3355
ATLANTIC BEACH, NC 28512
19 33
PAY TO THE /��
$ Xx
ORDER OF
D O L L A R 5
FIRgCMZENSBANK
Ars1-CRtz ns Bm* & Two CmTjx" 133
Atlantic Beach, N.C. 28512
FOR �.,n /" ,T
I:053L003001:131214853511'
0286

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Is property located at
qName of Property Owner)
.COT /0,0 looz14'
(Lot, Block, Road, etc.)
on , in /0z"V., 'g'04C.1' , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no object -ions to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Telephone Numbei-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
7-71
JUL
EV- 7-12n
7 92
I hereb certify that I own property adjacent to
6.6 .�,� Is property
name
loca ed at ,l 0 �--` Qy
OA."- D'c (Lot, Block, Road, etc.)
�� in hb;�)hzl A8a"--A-'
W er Body) (Town and/or County)
on
N.C.
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 DEVELOPMENT)
Si4rfature
ame_
Phone Number