10774_General Permit_19920914

LAMA AND DREDGE AND FILL
GENERAL ; ;
PERMITX ?�� a T74
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and e o tal Re mii
in area of environmental concernpursuant to 15 NCAC
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Project
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Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length _
number
Bulkhead length
Wax. 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.
Phon?"N6mber, -! 27- ?ZiY
(SCALE:
applicant's signature
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance. r� �l� �l f �Q 1,2,The applicant certifies by signing this permit that 1) this pro- fir,
Ois consistent. with the local land use plan and all local issuing date expiration date
ns, and 2) a written statement has been obtained from
aacent rinariar, lan owners certifyine that they have no
o iectl�he proposed work. attachments
In issuing this permit the State of North Carolina certifies than''
this project is consistent with the North Carolina Coastal application fee 2-
Management Program.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I,'�aereby certify that I own property adjacent to
�i
's property located at
NameCbf Property Owner
(Lot, Block, Road, etc.)
on , iA /�-1 r , N.C.
(Wa erbod (Town aid/or County)
i
He has described to me, as shown below, the development he is
proposing at that loc ti n and, I have no objections to his
proposal. /-a )q- U�
---------------------— rs.— O--------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
,To V— filled in by individual proposing -velopment)
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/11Ito FVd�'V &a4w"
W 3,yt e
Signature
S+eve- 5 rN arA
Print or Typ& Name
726 -321
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I r
hecertify that I own property adjacent to
-L 's property located at
(Name of Vtoperty Owner)
'(Lot, Block, Road, etc.)
on s in , N.C.
(Wat rbod ( own and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and I h ve no objections to his
proposal.
---------------------I/- - ---------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
l �
Sicf' ature
AL11 AtJ
Print or Type Name
9(G- 52-S- �87
Telephone Number

T ... •.. ... .
w .;........L'\I1ED 51,,11ES POSTAL J1ONEY MH)],'
ow
46613408995 920914 285570 * 5 0 * 0 0
PAY TO `b
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COD NO, OR
USED FOR
0000800 21:
CHECKWRITER
IMPRINT AREA .
C ADDRESS
4661340a995o
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GEXERAL PERMIT APPLICATION INFORMATION
APPLICANT'S NAME:
( (Fi
t( ft
ADDRESS:ANENT)
f ddle
41i
Last
STATE 02; L, ZIP oT�,J e1
TELEPHONE: WORK ( ) HOME ( ) J 0 ��yy
CONTRACTOR'S NAME: TELEPHONE NUMBER �— ,`i
PROJECT LOCATION: N.C. Hwy. # SR # Road/Street Name`
Waterway Name County
Town �� u , Subdivision
PROJECT ACTIVITIES:
PIER: Total dimensions of pier from MEW to platform
(Length) (Width)
'T' or 'L'-head platform
(Length) (Width) (Number of Mooring Piles)
Water depth at end of pier
TO HOUSE/BOAT LIFT:
Length
Number of Piles
BULKKF D: #1 Total length S-2-0 f
Average distance waterward MHW
Number of Mooring piles
Maximum distance waterward MHW
#2 Total length --P'Q..g�t
Average distance waterward MHWi
Maximum distance waterward MHW�
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY']
Length Width
Width
Water Depth
Base width from MHW
Depth of Cut
Adjusted water depth on MLW Existing water depths)
Estimated Cubic Yards (length x width x depth/27)
Type of spoil: Sand Mud
•Dragline Backhoe
OTHER STRUCTURES: 4 // /r r�
Hydraulic