19826_KALOSKI, DANIEL_19980513

O
Applicant Name _
Address
City
CAMA AND DREDGE AND FILL (�
GENERAL .�� ��` �� 4526-�
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
Phone Number
State
Zip
Project Location (County, State Road, Water Body, etc.)
z'
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
J 7Pi_:.
(SCALE: )
�er
K,4i.GCic f ?(,PE r
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.
applicant's signature
permit officer's signature
issuing date expiration date
attachments 6,H Ile
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

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DANIEL_V._KALOSKI__ _ 2591
=LINDA L. KALOSKI --: _
P O BOX 36 919-249-0469 =_ -- -
66-152/531 CC
ORIENTAL; NC 28571 3 `yV�(
Pay To The_ -
Order Of / " �' U City _-5j .�•v
Dollars
A OVIA -
Wachovia Bank, N.A.
Uarboro, NC_ 28313
52 _.
em
53LOL5291: 0784 203374ug 2591
N LMD 1992

Pamlico County Building Inspections
P.O. Box 776
Bayboro, N.C. 28515
(919)-745-3861
Adjacent Riparian Property Owner Statement Epn#
I hereby certify that I own property adjacent to ! ",t6d 1 -<4(o -) L `s
Name of landowner proposing development
on ( n t v)(d in/near Lot# of �l
Co unity Subdivision, if applic le
Tax Parcel #
off SR
Complete description of how to locate this property:
This proposed project, a 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.
1
After this form is completed by the landowner 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
Inspections Office for building permit application/processing.
Signature: i� l Vic' , o z< L/ Date '3 'CT

/ IY
Pamlico County Building Inspections
P.O. Box 776
Bayboro, N.C. 28515
(919)-745-3861
Adjacent Riparian Property Owner Statement Epn#
I hereby certify that I own property adjacent to 1.0 n 1 �'� V • Koji k ll `s
Name of landowner proposing development
on Oz U P in/near Lot# 3 of �i-t �� �.2e�
Commu ity Subdivision, if appli able
Tax Parcel # off SR
Complete description of how to locate this property: _
This proposed project, a brfa LwTt� , 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:
Y
— 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 landowner 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
Inspections Office for building permit application/processing.
SignatureDate