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HomeMy WebLinkAboutExempted_Waters, Geneva_19950411 POBOX 776 •PAMLICO COUNTY BUILDING 1NSPECI'IONS\\ BAYBORO, N.C. 28515 (919) 745-3861 (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 aqd other applicable required information, to the Building Inspections,- Office for building permit application/processing.) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN# I hereby certify that I own property adjacent'to f [1D)"),_ Is on .nQ � U uc cJ i �!! cam• Name of landowner proposing development body of water in/near Lot# 1,0 of community Subdivision, if applicable - Tax Parcel # L 0 off SR Complete description of how to locate this property: The proposed project, a and the location has been described to me as shown in the drawing below and 1 have no objections to the proposal. FOR A PIER, CHECK ONE OF THE FOLLOWING: _ l 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. /6 . , 120-2� r l printed Name . rd cao 0 0 �ce �%� Date,2-,�6 J,�Signature 1 ' 28515 1 OBOX 77G PAMLICO COUNTY BUILDING INSPECTIONS BAYBURU, N.C. P (919) 745 38G1 ik r the landowner proposing the project, (After this form is completed bynsent and a copy is given to his/her adjacent landowners f wittheir bu lding plan C - atures. he forms are then returned, along a Building Inspections' sign applicable required information, to th amd other rocessing.) permit application/p Office for building ADJACENT RIPARIAN PROPEK'PY OWNER STATEMENT EPN# I hereby certify that I own property adjacent to _' s on �, , .c is ---- body of water Name of landowner proposing development i,ot4tVL" 1 0�of in/near Subdivision, if applicable community :. off SR_ — Complete description of how to 'lax Parcel 4P J�- locate this property:'" cu�e.,.. 00- and the location has been The proposed project, a -_____— 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: _ l wish to waive the 15' minimum setback from my riparian access. I DU NOT wish to waive the 15' minimum setback requirement. hk>,k4r9rir�r4r4rt4et49ck4r,e3r9rYs4tirkd:o2,ketuaYsr4,YYx4r>lex,kxYklded below. List the size Draw the proposed structure in the space p l'OV 4 of the structure and measured distances from the adjaent ac water opetcy ert lines, other structures on the property, and the road 2-ev �' Date.�kr7 Signature . Printed Name . s•