18479_FULLINGTON, BILL_19971106

CAMA AND DREDGE AND FILL
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GENERAL �P
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
Applicant Name /e. i
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Address
r
City f/f� �lscrt�
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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r1Y
'/ A
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.
Phone Number `i.'Yi`.Si-}� �'✓ '
to !V6 zip �970'-'
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applicant's signature
permit officer's signature
issuing date expiration date
attachments 0-;//• Z 10
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee ��o� 3)
Management Program. pc , i

BROAD CREEK 66-30
/531 2831
CONSTRUCTION INC
PH. 919-219-0523 Q�
11 CREEKVIEW COURT
MERRRRITTT, NC, 2{8556 �—
Pay to the
`�/��� $ S
onler o
wars
FIRST CITIZENS 411
FirslbCilizons Bank 11 Trust Company
Bayboro,NA 26515
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11 �
POIL 77G PAMLICOCOUNTY BUILDING INSPECTIONS BAYBORU, N.C. 2 515
i [phone]
(A -ter th!is form is completed by the landowner proposing the projec ,
a d y is given to hips/her adjacent landowners for their consent an
si ature�. The forms are then returned, along with a building plan
an ether 4plicable required information, to the Building Inspections,
Of ice for building permit application/processing.)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN#
!i Ij I hereby certify that I own property adjacenL to
s on e-
Namb landowner proposing development body of water
in),I eat'-�" 7 �- .r �_z._= Lot# � of P
community: Subdivision, if applicable
Ta ;Parceli# off SR Complete description of h'w to
10C to this property:
Thy proposed project, a l=>2 �y 5���. �:,�z "and the location has been
desCribed to me as shown in the drawing below and I have no objections
to'Che proposal.
FOR A PIER, CHECK ONE OF THE FOLLOWING:
�II wish to waive the 15, minimum setback from my riparian access,
I DO NOT wish to waive the 15' minimum setback requirement.
Dr Withe proposed structure in the space provided below. List the size
c' tlhe structure and measured distances from the adjacent property
lines, other structures on the property, and the road, water, etc.
Tinted Name

t
185'
u%�710
2 36r NgS.Iijh) U G
TD. 46^ IOd �Pl lAorA
I
Y
D I�7t 3/,f GHA
II

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Bill Fullington 7s
(Name of Property Owner)
property located at Lot #3 - Fork Point
(Lot, Block, Road, etc.)
on Brown Creek ,in Pamlico County N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Signitire
Andy Anton
Print or Type Name
757-340-4467
Telephone Number
Date: Tk 6