21007_SALISBURY, CHARLES VAN_19981110

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1016,
CAMA AND DREDGE AND FILL N�®00"�
GENERAL
�Mc tc.c� CO .
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
Applicant Name
Ci , ZlX • �n� �.�t.tS� ,;•?_y Phone Number 222 •2-1�2i, -2 7(p i
Address = ��� 'vim I w /•�
City State Zip ? '� ? 5
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity '�"��"'���r\ �2•"
t r2.L.151 c l�
PROJECT DESCRIPTION
SKETCH
(SCALE:
Pier.(dock) length
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Bulkhead length
FLA
max. distance offshore 'r T.
B In. channel dimensions
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B(?$t,+aJT- imensions
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This 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.
applicant's signature
permit officer's signature
Icy pub;• Gt s> it'Pi .6�d
issuing date expiration date
attachments u �' 00
application fee
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6863561,8591 981
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a ����`
587� *100*00.
SERIAL NUMBER YEAR, MONTH. DAY POST OFFICE U. S. DOLLARS AND
PAY TO
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CHECKWRITER �, MJI cI `t'
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USED FOR 1,�-�eM•1�o
NEGOTIABLE ONLY, tI tHE U.S;AND POSSESSIONS
\�mdoon0800 21: 686 3 36 la S9 111'

Pamlico County Building Inspections
P.O. Box 776
Bayboro, N.C. 28515
(919)-745-3861
Adiacent Riparian Property Owner Statement Epn#
I hereby certify that I own property adjacent to Charles van Salisbury, Sr. `s
Name of landowner proposing development
on ORIENTAL in/near Lot# N/A of
Community
N/A
Subdivision, if applicable
Tax Parcel # Map #-I092-26 off SR -1308
Complete description of how to locate this property: ORIENTAL - ON LEFT of BRTMF
HEADING TOWARD MINNESOTT
This proposed project, a ' w-V-OoeL) , 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.
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 �`'Z i %��� '�� Date
DEATON

11/09/1998 09:12 18606283381 DERYNOSKI ELEM SCH PAGE 02
Pstmlics County Building Tasptctiam
P_U Box 776
Bayboro, X.C. 29515
(919)-745-3861
Y hereby cwtify tilai I own property adjacient tom t`►,Ariw.a Vwn ngj ; b,n*. Cr `$
Name of laltdowmr proposing develePmt A
on #3RT I - Wnesr Y ot# of N/A
Connmtm4 Subdivision, ifapplicaWe
Tax Path] # Mh>1-109—26 off SIt_1308.
Complete description ofhow to Locate this property: PHISRM, _ QN r.F-F-r -Vursw PWT TIF - —
This proposed project, a flJ � - , and the location has been dose *od to me as
shown is the dmwii* below* and i nave no objections to the proposal.
For a Pier, check one of the FollowmW
— I wish to waive tin 15' mm'mum setback from my riparian ancess-
_ i dry not wish to waive the W uinimum setback requbmnent.
Draw the proposed-Wimure in the space provided below- list the sires oftbe structure and
IYt8 w—ed Iitsmees from the adjacent property lino, other struatures on the property, and the
road, water, etc_
JiflQdix f9m is m s-i br Ll- 1-dor+iar ll( *& P -9 - I a WW is zi%%,m to er ll�l �wdOftm &C d)-* await:) Wd
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4f6a � � per
signature Data ZZ - 4f` 5I'
RaYzibnd zversan
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