22239_SMITH, R. T._19990524

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CAMA AND DREDGE AND FILL
GENERAL NI? 22239 c
PERMIT 7
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 15A NCAC
Applicant Name
_' ', ' Phone Number `-1 !C)
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
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Type of Project Activity �� r�.i.i + i�x — ��,� c.�x iX rL ;sc i'-{ '� !�lw�r-l)i,}�1 ty 1��\ �7"A21� ()Z
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PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length `Jul t� C�,ry A c l
t_
Groin length
number
Bulkhead length -
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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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.
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applicant's signature
r
permit officer's signature
issuing date expiration date
attachments i ) 071 !2/
In issuing this permit the State of North Carolina certifies that
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 j
's property located. at LO-1 Qrle'tj d'eI
' (,l � J (lot, block, road, etc.) 000U00
onPon �hanne-( in Eir 1��� T� N.C.
(bodY of water) town and/or county
The proposal has been described to me as shown below; the development, a
pier,�bulkheadstructure, and the proposed location, and I have no objections
to the proposal. I understand that if the development is a pier, it must be
set back a minimum distance of 15 feet from my area of riparian access unless
waived by me. I do Lo
ot ish to waive that setback requirement.
Des=ipticn and/or drawing of ptropcsed developrat: (to be filled in by individLral
pnq-csing develq=mt. )
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(Original must be retairnd in the In pectirn De:ortm t)
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SignaturLd
-�&[)L&/ �' 5-glTik
Name (Please Print)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to R . —I, S IM + + \ 's
_ (Name of Property Owner)
property located at
(Lot,; lock, Road, etc.)
onin ' ram! - 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 objections to his
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Print or Type Name
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Telephone Number
Date: