18668_BRINSON, DON_19980602

O
Applicant Name
AAA
CAMA AND DREDGE AND FILL
GENERAL �� Q
PERMIT
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
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
Phone Number
Zip
PROJECT DESCRIPTION SKETCH (SCALE: )
Pier (dock) length
Groin length
number
ulkhe th
1.
Basin, channel dimensions
cubic yards
Boat ramp dimensions i
Other f}
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, applicant's signature
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's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
jectissuing
is consistent with the local land use plan and all local g j
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

LIBERTY
151 LINDA OR WAVERLY D. SHORE
DBA PAMLICO MARINE CONST.
HER NCDL 4789098 HIS 3266479
PH. 919-745-7992
P.O. BOX 163, DIXON RD.
VANDEMERE, NC 28587
PAY THE & � �
ORDER OF �/
/✓/ 7 V � e
WInH 8aI M
MEMO �' a
1: 2 5 3 17 7 9 68I: 00 17 90 611■
58 24
824
66-7796/2531
OLLARS

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Izy2,
Adjacent Riparian Property Owner Statement.
SIGNA -�� DATE
I hereby certify that I own property adjacent to
on , RI led in/near Lot#
Community
Tax Parcel#
Complete d
off SR
c,-J a?/ //" fV"/
Of
Name of landowner proposing development
Subdivision, if applicable
This proposed project, a F4 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 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.
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.
0
o4
After this form is completed by the landpwner proposing the project, a copy is given to the 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 Insp. Office for building permit application/
processing.

Adjacent Riparian Property Owner Statement
SIGNATURE
- 2��. - A��
DATE ' —/ SY — `/ S'
I hereby certify that I own property adjacent to po n/ G� �/---'' •'>
Name of landowner proposing development
on /4�2 in/near Lot# of
Community
Subdivision, if applicable
Tax Parcel# off SR / / / 7
Complete description of how to locate this prope _6 Le y P7" ge v
l
9 tG
This proposed project, a�rand tthe vlocation
a
has been described to me as
shown in the drawing below and I have no objections to the proposal.
For a Pier, check 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.
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.
After this form is completed by the landpwner proposing the project, a copy is given to the 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 Insp. Office for building permit application/
processing.