11450_General Permit_19930804

Applicant Name _
Address
CAMA AND DREDGE AN D FILL
GENERAL d rJ �- 11411,541
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Costal Fesources Commission
in an area of environmental concern pursuant to 15 NCAC %%- /// / r
v42 L' ,
Phone Number
City �' ;O p o Stater / " (_ zip
_ I _
Project Location (County, State Road, Water Body, etc.)
0 /&2_7Frj c�
Type of Project Activity �_ t� tJ
n A. ,(PF-r-
PROJECT DESCRIPTION
SKETCH
(SCALE: )
Pier (dock) length
t
Groin length-
number
Bulkhead length
-
max. distance offshore'
Basin, channel dimensions
�t
�
J ---
cubic yards
I
4--
—
Boat ramp dimensions
i
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.
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.
� r
!applicant's signature
cl ✓1 �(.i / l`
' permit officer's signature
issuing date If expiration date
attachments / /6y
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee
/1 <'; <` . <� O

09102
DAVID SIMPSON CONSTRUCTION CO. INC. 66-301531
RT. 65, BOX 384. 919-249-1381
ARAPAHOE, NC 28510
19-2�3
PAY
TO THE n%
ORDER OF
O C
O DOLLARS
FIRST CITIZENS BANK
First-Cltizens Bank & Trust Company 1
Bayboro, N.C. 28515 FOR ` ,
V .
` II 1:0 5 3 L00 3000 ? L L00 70 911,

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9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Dr. Vernon Rose
property located near the end of SR 1218
(lot. block. road. etc.)
on Bay River near Maribel ,
(body of water) (town)
North Carolina in Pamlico County. The proposal has been described to me as
shown below; a development, a bulkhead, at 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 ish to
(cir e)
waive that set back requirement.
Description and/or drawing of proposed development. (to be filled in by
individual proposing development) INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND WATER.
The proposed development is a continuation of the existing wooden
bulkhead for an additional 60' +/- on the west side of the Rose
property, including a 10' +/- return.
*********************************************
(Original must be retained in the Inspection]
LDATE
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Receipt for
Certified Mail
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IIMTED STATES Do not use for International Mail
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(See Reverse)
Sent to
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P.0 , St and ZIP Code
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