62259_Pier with L-head Platform_20171027

LAMA / GE & FILL' 2N2 7061$1` A
PERMIT Previous permit
New.. ❑Modification E]Completd'Reissue El Partial, Reissue Date previous p . q . rmit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal -Resources Commission in an area of environmental concern pursuant to 15A NCAC
;Xl Rdlei attached.
Applicant Name �Syjj�iA �. -Etml A t,) Project Location: County L
Address CI-Oo91 VW'VAI-, 411.L,4 Street Address/ State Road/ Lot 9(s)-
city State 1a ZIP 2-7 � D3 C1 7- r U-:,r C1 Aet IQ
Phone # ("I) LkA- 4'&72 E-Mail - Subdivision
Authorized Agent T T ' _5 �1 P4_1 lrc City -.-ZIP
EICW DEW ;4PTA DES D PTS Phone # River Basin )A-a,PAOL,16,D­,
Affected El OEA D HHF El 1H 0 UBA El N/A
AEC(s): Adj. Wtr. Bod 4�Qnat /man /unkn.)'
El PWPNA' yes
S:
ORW: yes Closest Maj. Wtr. Body
/� �no
Type of Project/ Activity LJ //I- j is
(Scalleii
Pier ( ►
Fixed
Floati
Finge
Groiid
Bulkl�
Basin
Boat
Boat
Beac
Othi
Shor.
SAV.
Mor
Phoi
Wniv
ti
A building permit may el�quired by: ---i 'vw ") v I �' •t�-1 See note on back-r9garding River Basin rules:
Note Local Planning jurisdiction)
Notes/ Special Conditions l� 14 _> I-- -T-7 F I ON C-1 to O J-' i
17.
(P L L
r� & Pi- iA,,e_ e A-rr71-L..a.,-
Platformw a,
"RIM
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ng Platform(s)
r pier(s
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On
■■■■■■■
length
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numbe
ead/ Riprap length
avg distance offshore
MEN
No
MEN
max distance offshore
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yes no
No
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MEMEMI
sommmomm
Lrium: n/a yes�
NINE■IMMIMMEME
go
es: yes
er flat e vpq no
r,
Signature
Please read compliance statement on
N1
1A I" Ic L-1 r Z-.C> CD b�
Application Fee(s)
7* of iermit*
5
. Check #
Issuing Date -EOirati6n Date

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19 uthorized Agent Consent Agreement
�, >i� - /�'�l�✓ �3/� , herby authorize Tobimm Jay Tetterton of
(Property Owner(s) )
TJ's Marine Construction, LLO to act on my behalf in obtaining LAMA permits for
the location listed below.
PROPERTY ADDRESS:
41 t ?
ue &,�2& A Za4 e,—
PROPERTY OWNER'S MAILING ADDRESS:
Phone No.
PROPERTY OWNER'S SIGNA'
AUTHORIZED AGENT SIGNA
DATE: o �- 20L
W/Authorized Agent Consent Agree.

A JAdEH-r R8 AMi4-PRQPEROWNER STATEMENT
I hereby certify that I own property adjacent to 0kJ A 's
(He a f Pr pew owner)
property located at l/ ®/' el
�e (Addres% L , �8 , eta.)
on In N.C.
( laterb®d}y) (utylTown and ar County)
- - - - The appli t has described to me, as shown below, the development proposed at the above
to lion.
Adlmnt I have -no objection to this proposal:
Pramw
armer 1 have objections to this proposal.
Chm* ane
®ESCREPT90N ANDIOR D Al WHG OF PROPOSE® DEVELOPMENT
?1ndsvidual proposin'- g development must fill in descripfion below oP a€faeh a site drawing)
C�/)
­_ _/
Adjacent WAIVE SECTION
v I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lilt, or groin
Owner must be set back a minimum distance of I5' from my area of riparian access unless waived by
Mat me. (if you wish to waive the setback, you snua
-- ialt,BnitiaY the appropriate blank below,)
is iEI'oi -
2-1 do wish to waive the 15' setback requirement.
I do not wish to waive the 95' setback requirement.
(ProperbJ Owner 9nf WMaU0nJ Mdlaeanft Pr oedhv OwneK U - n1
,C
,-TITOphone IV, erf email addrsV
(Revised Aug. 2014)
Walid for one calendar year after signature

! hereby certify that I own property adjacent to �f 's
C� j @me tFTOPATV GWrae1}property loca ed at Q� / SI U /7/: I - n C/1---.
on
In
N.C.
(Wiraterbooly) (Cibi/Town and/or County)
- - - - The applicant has described to me, as shown below, the development proposed at the above
location.
r3: I have -no -objection to this- proposal:
prsn�r
°•�_+� 1 have objecffons to this proposal.
Ci�w; a:Fe
lea e l at pt��jb sing s�evel� i aeait,mlus$ trill an-d serf fioniol$ r al 2c a s� a yet 8�a )
Q,
WANER SECTROM
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If y wish alve the setback, you must -initial the appropriate blank below.) '
do wish to waive the i5' setback requirement.
I do n6t wish to waive the 16' setback requirement.
(PrapeMj Owner onfarmai:-ion)
(RevisedArag 2094)
Nalid for one calendar year after signature ,

70VVN OF BATH
BATH, NORTH CAROLINA
DATF----/d
BOOK NO. PERMIT FEE ---PERMIT No
APIPLi3CA IGN FOR: BUILDING PERMIT( ) ZONING COMPLIANCE CERTIFIC,4I E (%)
Name & License No. Address: Phone NO.',
�1
OWNER GL3 ���' 4j7 --o
CONTRACTOR
RACTOR ,5 �tal'�r1 G F)/1.57'" . rl=f���•n /lC' ?>��/� ��
DES?GNER
SURVEYOR
ELECTRICAL
PLUMBING
TYPE OF IMPROVEMENT
NE°VV e Z)ADDITION ( ) ALTERATION: INSIDE ( ) REPAIR: INSIDE( ) MOVE(
OUTSIDE( ) OUTSIDE( ) LOCATE( }
Lot No. Block No. Building located a . TS e--,
betweeomk—
and Streets. Building to b,. used as
. i A I /�
Type
Number of off street parking spaces . Contains rooms and
bath(s).
T ota) square feet of building Electric Service Type of heat
No. of plumbing fixtures . Foundation block caps
4" ( ) 8" ( ). Corner bracing: Plywood ( ) other . Insulation: Floor
Walls , Ceiling . Windows: Storm ( ) Thermal ( ). How many exterior doors.
Water Heater: Gas ( ) Electric { ) Other.
Roof Ventilation: Gable ( } Eaves ( ) Louvers ( ) Other Ventilation,
crawl space, number of feet apart . Height of crawlspace under house: 18" ( ) 24" ( }
Other Zone . Water and Sewer Tap: Paid ( ) N/A ( ) Size water tap
Size sewer tap: . Total Estimated Cost Food elevation

BUILDING INSPECTION DEPARTMENT COMMENTS:
IS TW I 7He C"Wt- ® F 10 t-0 7 ' ArJ o / t6&T$ 1
M
CITY LICENSE NUMBER:
­, 1262,f-g�z
Contractor,
Application approved by:
Electrician
Plumber/Heating
/Q-/D—/'7
The owner of this building and the undersigned agree to conform to all applicable laws of the Town of
Bath, orth Carolina
ignature of Applicant
Effective 8/10/04, there is a $50.00 filing fee for all permits, including zoning compliance application.
Any construction that requires installation of water or wastewater services may:
A) Be installed by owners, contactors or
B) Be installed by Town of Bath Utilities Department
All components must be compatible with existing water/wastewater materials, including Myers pumps.
Bath Utilities Department must inspect all construction prior to services becoming operational. Inspection
fee is $100.00.

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