13838_FISKE, WILLIAM_19941128

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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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 Qr%f� • f %C,0
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Applicant Name 'c'``' 's Phone Number �"
Address d - , ,'_—/
City <' �, 4, f State Zip
Project Location (County, State Road, Water Body, etc.) %"" '`w ' 41", S. f'' ,Lrt
Type of Project Activity�'f�Cx f�
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PROJECT DESCRIPTION SKETCH
Pier (dock) length �^
Groin length
lumber
Sulkhe'dd length
max. distance offshore '
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other e
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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.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
applicant's signature
permit officer's signature
issuing date expiration date
attachments .� //0 U
application fee 460 r14 - 10�_ V/V

I �Q LAW 7RUCKlNG 112 CSERVICE '
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MERRCOURT 919-249-0523
ITT, NC 28556
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PUBOX 77G PAMLICO COUNTY BUILDING INSPECTIONS BAYBORO, N.C. 28515
[phone]
(After this form is completed by the landowner proposing the project,
a copy is givelz 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 EPNIP
I hereby certify that 1 own property adjacent to
CcS �5 Is on CtreeL
Name of landowner proposing development body of water
in/near 0 r 1 .ti Loth of
community Subdivision, if applicab e
Tax Parcel # off SR, Complete description of how to
locate this property:_
The proposed project, a �U l c/
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.
+*�,r,r,�*s,►*,r**,ts,►•,►,►,rx�tr,r,r***,r�,r,►*,r***,t*�+r,e,.*�,r***,r,r,r,r**«,r,�,rx**,r*f,r*�,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.
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Date9 Signature 0 ,

PO.WX 776 PAMLICO COUNTY BUILDING INSPECTIONS BAYBoX0, N.C. 28515
[phone]
(After this form is completed by the landowner
a copy is given to his/her adjacent landowners for their co sentjand,
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#
t hereby certify that I own
i�wf I
property adjacent Co
Name of 1 c 's on
downer T
proposing development body �ater
in/ �C— Lot# of
community ""� � J- `�"
Subdivision, if appl' able
Tax Parcel 40off S
______. Complete description of how to
locate this property: j - __ %o -+ L _ ( ^
3 c=�
The proposed project, a v �h to ✓
and the location described to me as shown in the drawi below and I have no objections en
to the proposal.
FOR A FIER, CHECK ONE OF
— I wish to waive the 15, minimum setback from FOLLOWING:
rom my riparian access.
I DO NOT wish to waive the 15'
+�**�*#�+►***t*,►**�s�,t,r�+r*+t��*,r�,t,r,r,►r�►��►,►aum back **,r,►+t,►q,►*«***,r*+r*+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.
Sao
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LOOT `)To fRoPoXza bock 6 APPZo1CtMATfLI/ �©
For-,
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Date -7 Jig 141 Signature `� �Q
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