10889_General Permit_19920909

CAMA A DREDGE AND FILL
GENERAL
PERMIT P_Nq 10889
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources anthe Ctaallesources Commission
_d
in an area of environmental concern pursuant to 15 NCAC ' /' I 1 D ?
Applicant -Name
�
Address A
City v
Project Locatin (Cou
r ) /I-," _ A/ _e.,
Type of Project Activity
State Road, Water ody, etc.
/�-e(,9 /<., `<
PROJECT DESCRIPTION SKETCH �t �� A
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
f
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
'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.
Phone Number 91 2` 9 6 7 - k ke,'
State r zip
'(_fII Rd
(SCALE:
a
2
C
J applicant's signature
1
(� permit officer's signature
issuing date expiration date
attachments v C —7/ 4 r l " o
In issuing this permit the State of North Carolina certifies that ,)
this project is consistent with the North Carolina Coastal apptication fee ! _ f/ jf
Management Program.

CHECK IS IN PAYMENT OF IhL FOLLOWING
MILLER'S CONSTRUCTION COMPANY rT� U �-QU 2892
P.O. BOX 25
MERRITT, NORTH CAROLINA 28556
PHONE [phone] FIRST CITIZENS BANK
& TRUST COMPANY 66-30/531
BAYBORO, NC 28515
\ \ _ DOLLARS
PAY
`M\\ DATE CHECK NO. AMOUNT
TO THE L�
1�
ORDER OF
AUTHORIZED SIGNATURE
11500 289 211' j:0 5 3 L00 300i:4 7 L LO 20 L 261r

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ADJACEI.'T RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify th11a``t I11 own property adjacent to
�Aa I� l� C_ IF(�Ood.IZwA ' s property located at
(Name of Property owner)
(Lot, Block, Road, etc.) 1
on 1341 1`" vi r2 in MC -Sic- - SAJ GPI: N.C.
( aterbody) (Town and or County)
i'? t:c ���� :"�1i '� �o me , as shown tiJ' elow, -tile de JeiGpaTl - nt hC 1
proposing at that location, and, I have no objections to his
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
To be filled in by individual proposing development)
S E L A AJ C Jb, 0 "� "J
00 4,� 0,AL]i A ),CO.V. m�-'+
cn s C�nr .
Signature
/-
Print or Type Name
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that',``I own property adjacent to
i O rn AA�(L4 �� c, INOoc'2Is property located at
(Name of
perty Owner)
S. R. 1221 - L3 ' s � Al t jc
(Lot, Block, Road, etc.)
on &4 �% oci , in &SIc_ gal 6Zo.•-le- Cpmwv,, N.C.
( aterbody) (Town a d/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)
St t /1H4G,OC D PZAw1 N !-
I .4 �b k . � � O C<J
25 � x .9 s � �o� � I?fis;fj fil C J J
2aC, ST l N CArJA I
y
Signature
RAerrt S hn,n 2 r
Print or Type Name
oll°\ gal 3SV)
Telephone Number

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