26675_NIXON, JIM_20000915

Your project is subject to the NC Divisio12,
of Water Quality Neuse River Buffer Rules �f
CAMA and DREDGE AND FILL due to its location within the Neuse Basin. 3
GE N E R A L Please contact Deborah Sawyer at
252-946-6481. -
PERM I T
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
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 become null and void.
This permit must be on the project site and accessible to the permit of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project 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.
Phone Number
Zip
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

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Pamlico County Building Inspections
P.O. Box 776
Bayboro, N.C. 28515
(919)-745-3861
Adjacent Piparian Froj&M Owner Statement Epn#
I hereby certify that I own property adjacent to .s
Name of landowner proposing development
n
Community
Tax Parcel #
Complete description of how to locate this property:
in/near Lot# �L of
off SR
�o�Fs� 5 LiOZ ES
Subdivision, if applicable
This proposed project, a l7 o , L , 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.
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.
\ ojE>✓ �T"fA��6�
After this fain is completed by the landowner proposing the projoct, a copy is given to the ac3aoent laudowncra for then consent and
signanucA The forms ere tbcn returned, along with a building plea and other applicable mquuzd mfonnation, to the Building
hupoations Oflicc for bw1ding pamrt
Signatur . �� �! J Date

Pamlico County Building Inspections
P.O. Box 776
Bayboro, N.C. 28515
(919)-745-3861
AAdjacent %narian Prop:cM Owner Statement Epn#
I hereby certify that I own property adjacent to Ji H r,),k0a,1 `s
Name of landowner proposing development
M
Community
Tax Parcel #
in/near Lot# -�-- of
off SIB_.
Complete description of how to locate this property:
t-Datrbl SuozES
Subdivision, if applicable
This proposed project, a 0 ° L , 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.
—Z'-Ido 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.
Aftcr this form is complctcd by the landowncr proposing the prvjcct, a c,pv u givcn to the &d accnt larndowncss for thcir coc3ent and
The forms arc tbm rrtumcd, along with a bun ding pLan and other s rcquircd information, to the BmIding
Inspoc6cm Office for building permit ap
Signature Date �3