10704_General Permit_19920324

Applicant Name
Address
CAMA AND DREDGE AND FILL
GENERAL
PERMIT 10704
as authorized by the State of North Carolina
C °J
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC `7 L Iwo
o
c. r
-? 1
Phone Number ; �/
City . 11 i n/ ;--Ld+y State Zip/
P tl f; (C t St t R d t B d t ) �` A l0
ro�ec oca ion oun y, a e oa I JXq—r o y, e c.
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length -"
max. distance offshore r
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
(SCALE:
l NW L_
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
u permit offi
cer's signature
issuing date expiration date
attachments
In issuing this permit the State of North Carolina certifies that (_, a�
this project is consistent with the North Carolina Coastal application fee
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Name of
ty owners
)W�
's property located at
(Lot, Block, Road, etc.)
on in 'F�r¢l' N.C.
(Waterb.dy) 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
Name dfi property Owner
,6e 1( o
j� (Lot, Block, Road, etc.)
onin N.C.
(Wat rbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Tnaturd /
(&-7 774 V. J EW9,S
Print or Type Name
119 — 71{ 5 - 533',2--
Telephone Number

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