16658_STAATS, PHILLIP_19970528

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� nCAMA AND DREDGE AND FILL^ w;
GENERAL p
-y- PERMIT �' V
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 Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
(SCALE: )
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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.
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` - applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

FOLEY & FOLEY CONTRACTORS, INC. WACHOVIA BANK 9089
PH. [phone] OF NORTH CAROLINA, N.A.
POST OFFICE BOX 3482 NEW BERN, NORTH CAROLINA 28564
NEW BERN, NORTH CAROLINA 28564-3482 66-1521531
PAY TO THE ORDER OFD. E. H. N. R.
5/28/97
$5_ . 0 0
fty and 00/00---------------------------------------------------
DOLLARS
Security features
In
included.
Details On back.
MEMO Staat 1 pi 6166S8-G
nv
11-009089111 1:0531015291: 5806 00090711'

POBOX 776 PAMLICO COUNTY BUILDING INSPECTIONS
[phone]
30a7 �I
BAYBORO, N.C. 28515~
(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. T,he forms are then returned, along with a building plan
and other applicable required information; to Ye Building Inspections'
Office•for building permit application/processing.)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT F.PN(1
.I hereby certify that I own property adjacent to
Phillip Staats• Is on Beards Creek
Name of landowner proposing development body of water
in/near Stevenson Sub Loto i of Stevenson sub
community Subdivision, if applicable
Tax Parcel It - - off SR //3-12-- . Complete description of how to
locate this property:
The proposed project, a- Bulkhead - and the location has been
described tq me as shown in the drawing below and I have no objections
to the proposal.
FOR A PIER, CHECK ONE OF THE FOLLOVING:
I wish to waive the 15, minim= 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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Date' i Signature
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POBOX 776 PAMLICO COUNTY BUILDING INSPECTIONS BAYBORO, N.C. 28515
(919) 74S-3861
(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 tPe Building Inspections,
Office•for building permit application/processing,) 11
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPNII-'
i hereby certify that I own property adjacent to
Phillip Staats• Is on Beards Creek
Name of landowner proposing development body of water
in/near Stevenson Sub Lot4)1 of Stevenson sub
community Subdivision, if applicable
Tax Parcel off SRi W Complete description of how to
locate this property:
The proposed project, a- Bulkhead and the location has been
described tq 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.
yo If
I -head
Dateicgnature