13190_DOUGHERTY, SHAWN & MARY, GRAY_19940901

O
LAMA AND DREDGE AND FILL
GENERAL 1,31 - C
PERMIT /(JqP1'
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 .:r c ,•, / �s{,.- . ,=,.;t
Address�L3 .Ta
City - r
Project Location (County, State Road, Water Bod c, r
Y, P-t ) �
Type of Project Activity /�e f's / 6'©
r.; Phone Number
<,r
_ State
39
r
6- C - AW61 T'i h
PROJECT DESCRIPTION
Pier (,dock) length
SKETCH
(SCALE:1
F,4
Groin length
number
Bulkhead length
i
o iii
`�
r
j
1tn4
61,PG
c
max. distance offshore
I
4
I°
!
Basin, channel dimensions
cubic yards
Boat ramp dimensions'
Otherit
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.
_ applicant's signature
permit officer's signature
19�� I max, I i t/
issuing date expiration date .
attachments (�' / s"r• / 200
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
& vU
application fee ' r Pt'/

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0743
CAMERON L. SMITH, JR. 66 25/521
NCDL 7571130 1)
314 KENNILWORTH DR.
GREENYILLE, NC 27858
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order of /i-�- •-_ „" s --
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Nu�ionnHnak of Nurth Carolina, N. � QR?� �
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PUBOX 776 PAMLICO COUNTY BUILDING INSPECTIONS BAYBORU, N.C. 28515
[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
signatures. 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. to
/ CYct Q G " ► s on - 6)1e.614, "I
Name of landowner p oposing d velopment body of water
in/near- (DT-�'P4:x Loto jof _ s ( O
community Subdivision, if applicable
Tact Parcel #
off SR
Complete
description of how to
locate thi_s�
property:
The proposed project, a 0 ) e-� , and the location has been
described to me as shown in the drawing below and I have no objections
to the proposal.
FOR A PIER, CHECK ONE OF THE FOLLOWING:
i wish to waive the 15' minimum setback from my riparian access.
I DO NOT wish to waive the 15, minimum setback requirement.
�*t►+r***+►*�r+t�,r,►�****,r*�t*�**Ran**���*i+►*,�:r**,►**,►***:«**�*********:,r***,r
Draw the pr osed structure in the space provided below. List the size
of the stru�ure %nd measured distances from the adjacent property
lines, other structures nn rha .,.-,,.,e.....
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NEWTOb,1N MAIL BOX FAX [phone] PAGE 02
0
PUBOX 776 PAMLICO CO�NTY BUILDING INSPECTIONS BAYBORO. N.C. MJIS
(919) 745•-3B61
(After this form ,is completed by the landowner proposing the project,
a copy is given 'to his/her adjacent landowners for their consent and
signatures. 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#
k hereby certify that I own property adjacent. to
/t/rr �- �d� ✓h O ' i on � +` <CA15 4
Name of landowner ®ropoiinaldevelopment body of Water
SCO ( Loff -
in/near �r � e+�.`� Lodi 5 of
community Subdivision, if applicable
Tax Parcel 0 off SR Complete description of how to
locate this property: }21 � 4�j� AZ1J t_A-(i� ' a-"
r i
Z&Y- SFr .�9 ��, ov iH i ctJ/ l--aZ°f
The proposed project, • t�1 �-r , and the location has been
described to me as shown irn'he drawing below and 1 have no objections
to the proposal.
FOR A:,PIER, CHECK ONE OF THE FOLLOWING:
t wish to Waive the 15' minimum setback from my riparian access,
/1 DO NOT wish to waive the 15' minimum setback requirement.
A**RRtiR*R!•RRRRRRR*RRR*RRlfRR*RRRR•RR*t♦f'RR'RRRRRRRRRRRRR!♦RRRR4RRR*RA
Draw the proposed structure in the space provided below. List the size
of the %tructure and measured distances from the adjacent property
lines, other 6Vluctures on the property, and the road, water, etc.
�40
1, M �Vl
57 59' ,
2. W � g
�+► c N fZ Lkate 2 Signature