14501_PARRISH, CLIFTON_19950302

O
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
�•`
1
X f � 1�5D1- c
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 6,211 116 --, r*-d
?/
Y A ,
Applicant Name V� ' " (7f' �`'S`' Phone Number '���' ��� ""�'`/
Address J
City
Project Location (County, State Road, Water Body, etc.) _
Type of Project Activity
State f4�r--• Zip�ya7 S
a�cf a.s w /fr• ,#•e� f'
•O•
Pier (dock) length
■ ■
■■
•
► .. �....
■
■■■
r
• =
w
■
rONO■■■■
■
i!■w*_
number
Bulkhead length'•
■�■•y
IW
�1�■i3tLi�■.■■■■■
�■,`�■�■■ER.■EV�■■
:'•F
■
■■■
■■■■■En
NM
■■■■■
max. distance offshore
■.I
%L
■■■■
•
■
■■
-�i■!�,■■■■■■■■■■■■
���■■■■■■■■■
■
oil
■■■
■
GYM■■■■■
cubic yards
mill
MI
R
0
Boat ramp dimensions
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.
issuing date
applicant's signature
permit officer's signature
Ali,•;;.:_ •`
expiration date
attachments • 0 2l / j/J 0 aw4 ' /Z(�o
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application feed
Management Program.

CLIFTON PARRISH 0367
PH 919-568-3565
P O BOX 27 HORSE SHOE RD 66-2581531
DEEP RUN, NC 28525 19 %Sf
PAY TO THE / ap
ORDER OF _ _ Jj `� �Q
Mt. Olwe/Calyoo/Grantham
AS i
Duclley/Seven Springs/Deep Run, NC,,��cc
FOR
1:0 3 LO 2586I:4907997878iit 0367
GrWi.WU iv�J

1VLs(!X 776 PAPILiCO COUNTY BU1LDM; iNSPECTIONS BAYBORO. N.C. 2BS15
[phone]
(After this form is completed by the landowner proposing the project,
a copy is given to his/her adjacent landowners for their consent and
sisnatuLes. The forms are then returned, along with a building plan
and other applicable required information, to the Building inspections'
Office for building permit application/processing.)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN4f
I hereby certify that I own property adjacent. to
's on to 6-
Naive of /landowner proposing development body of water
in/nearl� �" '' '- ` Lotd of
community Subdivision, if applicable
Tax Parcel !i off SR Complete description of how to
locate this property:
The proposed project, a
and the location has
been
described to me as shown in the drawing below and I have no objections to the proposal.
FUR A PIER, CHECK ONE OF THE FOLLOWING:
1 wish to waive the 15, minimum setback from ■y riparian access.
I DO NOT wish to waive the 15, minimum setback requirement.
##*Rf#########*##♦RA##wr#**,►A#A#**h*##R*####*##A##R#AfR###***Af#;#ttft•
Draw the proposed structure in the space provided below. List the size
of the structure and measured distances from the adjacent property
lines, other structures on the property, and the road, water, etc.
3G�
'c 1 L ak d Date 'ignature
�)' V

1'tJoX 776 YAMLIC0 COUNTY BUILDING 1N5PECTION3 BAYBORO. N.C. 28i15
[phone]
(After this form is completed by the landowner proposing the project.
a (.opy is given to his/her adjacent landowners for their consent and
si6natuLes. The forms are then returned, along with a building plan
and other applicable required information, to the Building Inspections'
Office for building permit application/processing.)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN#
I hereby certify that I own property adjacent. co
Name of landowner a on
proposing development body of water
in/near �i" •��' `' > �;^ :: LotO of
community Subdivision, if applicable
Tax Parcel # off SR Complete description of how to
locate this property:
the proposed project, a and the location has been
described to me as shown in the drawing below --'and I have no objections
to the proposal.
FUR A PIER, CHECK ONE OF
_ E I wish to waive the 15, minimum setback fFOLLOWING:
:
riparian access.
I DO NOT wish to waive the 15' minimum setback requirement.
•*+t*R*t�tt*t****#*R,►*�+►*�s**,►�t***r+►4tw,tt*r��t*s,��ts***�+tt**:***�:t,�*:r
Draw the proposed structure in the space provided below. List the size
of the structure and measured distances from the adjacent property
lines, other structures on the property, and the road, water, etc.
Date /j-ate --- iqnature