18788_PAUTENIS, JOSEPH C_19970731

CAMA AND DREDGE AND FILL G�
GENERAL �(91 `"788_-�
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 `� ;j Phone Number
Address
i
City /Ves State Zip
Project Location (County, State Road, Water Body, etc.)
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
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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.
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applicant's signature
_4 ,A,r f !e
permit officer's signature
attachments
issuing date expiration date
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In issuing this permit the State of North Carolina certifies that s
this project is consistent with the North Carolina Coastal application fee
Management Program.

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YOHUX 716 PAMLICO CUUNTY 111¢11.UING IN5FIXTIUNS HAYf OX0,, N C. 2U51:r
[phone]
(After this form is completed by the landowner proposing the project,
a cgpy is given to his/her 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 Ins ections'
Office for building permit application/processing.) /9Q �aX� c
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EP,O
� I hereby certify that Z own prope ty a jacent to
Is on
ane f land waer proposing development body of w ter
in/near ' �t"i���-�" Lotf1 � of
community Subd i ion, if applicable
Tax Parcel " �"J'"ff s /� � 5: Complete descriptior. of how to
locate this property.-'
The proposed project, a =-L� and the location has been
descri>.�ed tome as shown in the drawing below and I have no objections
to the proposal.
FOR A PIER, CHECIS 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.
P

POBOX 776 PAMLICO CUUNTY 111;11.DING 1N5P1:CT1UN5 BAYBORO, N.C. 26517
(919) 71-5-3661
(After this form is completed by the landowner proposing the P�dject,
a cgpy is given, to his/her 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 buildiag permit application/processing.)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPNO
I hereby certify that I own property adjacent to
is on
ame o 1 er proposing development ody of water
in/near Lotd-// of
community SubdiVision, if applicable
Tax Parcel #��"3^�—
off S Complete description,of how to
locate this propertyAki:
L11 -
The proposed project, a , and the location ba been
descri..ed tome as shows in the drawing below and I have no objections
to the proposal.
FOR A PIER: CHECK ONE OF THE FOLLOWING: 1
I wish to waive the 15' miniant- setback from my riparian access. -
I DO NOT wish to waive the 15, minimum setback requirement.
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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.
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Na,.�r.