10841_General Permit_19920721

CAMA AND DREDGE AND FILL
GENERAL
PERMIT r N 0 1 1
(Ul
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resourc ommission
in an area of environmental concern pursuant to 15 NCAC
Applicant Name Phone Number
Address
City . State r�� ` Zip s
Project Location (County, State Road, Water Body, etc.) ^�
,•- :" �' �' � "" �'� ; n"ti� F r rat ��= ly '�.. r
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) length
ri r
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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.
attachments
(SCALE:
applicant's signature
C.
permit officer's signature
issuing date expiration date
In issuing this permit the State of North Carolina certifies that / T.
this project is consistent with the North Carolina Coastal application fee { `' o
Management Program.

0614
DAVID RUSH CONSTRUCTION Z 66-30/531
P.O. BOX 190 ��( 1y 472 1
ORIENTAL, NC 28571
PAY TO THE C
ORDER OF �U Y
D O L L A R S
FIRST CITIZENS BANK
First -Citizens Bank & Trust Company 472
% t
Oriental, N.C. 28571 /
FOR
1:053100300':47 L 200485711' 06

ADJACENT RIPARIAN PROPERTY OWNER STATEr,1ENT
I hereby certify that I own property 'adjacent to Dan & Hesta Roach
property located atLot 6, Pelican Point Sub-div. , Pamlico, Pamlico Co.
(lot, block, road, etc.
On Broad Creek % in Village of Pamlico
(body of water) (town)
:;orth Carolina in Pamlico County. The proposal has been described to me as shown belc,,r;
the development, a Fier/bulkhead/structure, and the proposed location, and I have no
(circle one)
(A)jcctions to the proposal. I understand that if the development is a pier, it must
set back a minimum distance of 15 feet from my area of riparian access unless
!--y cie. . do do not wish to waive that setback requirement.
(circle one)
:--ription and/or drawing of proposed development: (to be filled in by individual
ci:x sing development.) INDICATE THE SIZE AND LOCATION OF THE STRUCTURE AND THE
S'I',ll'CE BM -TEEN EACH PROPERTY LINE AND THE WATER.
SEE OTHER SIDE
Elevated walkway and pier.
Walkway - 4`8" wide by 80' long.
Pier - 4'8" wide by 104' long with 5 tie poles.
(Original must be retained in the InspectioK�eparjtnent)
ure
-t Arniotes
Name (Please Print)

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ADJACENT RIPARIAN PROPERTY OWNER STAIEvENT
I hereby certify that I own property adjacent to Dan & Hesta Roach
property located atLot 6, Pelican Point Sub-div. , Pamlico, Pamlico Co.
(lot, block, road, etc.
on Broad Creek % in Village of Pamlico
(body of water) (town) — - -
::,)rtli Carolina in Pamlico County. The proposal has been described to me as shown below;
the development, a pier/bulkhead/structure, and the proposed location, and I have no
(circle one)
(A)iections to the proposal. I understand that if the develolxnent is a pier, it must
set back a minimum distance of 15 feet from my area of riparian access unless
by ne. i do/ o no wish to waive that setback requirement.
(circ e one)
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.:--riptinn and/or drawing of proposed development: (to be filled in by individual
sing development.) INDICATE THE SIZE AND LOCATION OF THE STRUCTURE AND ME
PRINCE BETn'EEN EACil PROPERTY LINE AND THE WATER.
SEE OTHER SIDE
Elevated walkway and pier.
Walkway -*4'8" wide by 80' long.
Pier - 4'8" wide by 104' long with 5 tie poles.
(Original must be retained in the Inspection Department)
I,
igna ure ----- - ...
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da e I
Paml i rn Prnneri- i cis & Developers Inc.
Name (Please Print)

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