10721_General Permit_19920515

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
C oP .
M 10721
as authorized by the State of North Carolina
Department of Environment, Health, 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
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
F,
cubic yards
Boat ramp dimensions
Other
Zip
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- `� applicant's signature
come null and void.
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. /
The applicant certifies by signing this permit that 1) this pro- f
ject is consistent with the local land use plan and all local issuing date
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 application fee
Management Program.
expiration date

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JONES ISLAND CLUB 1623 l
LOIS BALLANCE
P.O. BOX 8365 919-745-7342
HOBUCKEN, NC 28537
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PAYTO THE
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ORDER OF -� Ori� T V T .<%
a (S
DOLLARS
THIS CHECK IS LIVERED IN CONNECTION WITH THE FOLLOWING ACCOUNTS.
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