16160_DICKIESON, CARY & PAT_19970210

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CAMA AND DREDGE AND FILLS
GENERAL
E
P RMIT
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 '%' 110e")
Applicant Name f/�i ? �'r��� •- ars Phone Number
Address
City =��� State 7 zip lq&,77
Project Location (County, State Road, Water Body, etc.) ��' �a /4 r s irr —
7
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length -
number
i. .
Bulkhead length _
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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.
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attachments
(SCALE: 1, )
i
applicant's signature
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that /
this project is consistent with the North Carolina Coastal application fee
Management Program,

BROAD CREEK CONSTRUCTION INC. 6195 2065
112 Creekview St Ph 919-249-0523
Merritt, NC 28556 ss-30/531
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Details an back
0 FIRST CITIZENS
BANK IlaybafIrst-clfize"slook h flud Company
l�c1l � <�. loyopto, NC 2/515
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ONAFLAND
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PoBOX 776 PAMLICO COUNTY BUILDING INSFEGI IONS BAYBOKO, N.C. 28515
(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 EPN4r
I hereby certify that I own property adjacent to
1� G"AT �ICKIE Sp(� 's on (T)D OIL UCEK
,,
Name of landowner proposing development body of water
in/ ea- (�Mt-I CCU Lot# of
community Subdivision, if applicable
Tax Parcel 4F (% 8 i �2 off SR j .3 ( Complete description of how to
locate this property: S Q 13 17
2,09W',Xt-4MAM"(16'M,ty .
The proposed project, a s iONE 90CXHC4D , 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.
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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Q r t rtc.d NarT�-- �Cft } V S Date )� / ��Signature