12021_ROBERSON, BILL_19930929

CAMA AND DREDGE AND FILL®�
GENERAL ID, 4 N° PERMIT I-
Ias 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 15 NCAC
Applicant Name Phone Number /
Address_
City _ r` State t. Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION I SKETCH r ! (SCALE: �/J/ / )
f I/
Pier (dock) length
Groin length
number
Bulkhead length
1
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
4-1
Li
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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-
comef A applicant's signature
null and void.
This permit must be on the project site and accessible to the �i permit officer's signature
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 issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee '
Management Program.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
- A _/r t /-V o
Name of Property Owner
(Lot,
's property located at
, Road, ktc. )
11
% i
on kn,e inN . C .
(Waterbody) (Town and/4Yr County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
A
I
I
Signature
Print or Type Name
Telephone Number

WILLIAM R. ROBERSON fir. 6086
VERNA J. ROBERSON
a 6830 SWEETBRIER DRIVE 672-3629 +�� �y a
—�[ if±M FORT WAYNE, INDIANA 46804 71_19/749
n Yam{ `C/ l 0 o
$� --.
FORT WAYNE G
NATIONAL BANK
FOOT WAYNE • INDIANA 46802
.per'
1:074900 1,941:? I'll?5810684oilG11' 6086
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