19672_ROBERTS, ALBERT_19980916

O
CAMA AND DREDGE AND FILL
GENERAL
PERMIT
//4
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 )1�'� �`"''f 7 Phone Number J5� ' �`(5 ` �> 14
Address '= Z� i�t.c�'✓ ��� �r>c \
City _ _ t1r. i State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH ( } (SCALE:
Pier (dock) lengthasr �✓
iy S
Groin length
P6r f
number
Bulkhead length
max. distance offshore
Z
Basin, channel dimensions
c�
cubic yards
Boat ramp dimensions (Rocks
}
t
Other
Cg = i) s
YL1`` '�a tt/,ak-5
This permit is subject to compliance with this application, site �( jtp�—
drawing and attached general and specific conditions. Any L -caz 30
violation of these terms may subject the permittee to a fine,
applicant's signature
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
permit officer's signature
!4. ::t b
issuing date expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

A. C. Roberts 66-30/531 2213 --
Ph 919-745-4814 471
2233 Hwy 306 S ,Q
Grantsboro, NC 28529 DATE '°-�__
PAY TO THE )DI^� so
n ORDER OF
—)-j �f - --------- --DOLLARS
a on icro Print signature line, gray type and linework. First Citizens Bank logo on back. If not present. do not cash.
I � ]FIRST CITIZENS 471 -
RANKFirst-CitizensBank $ Trust Company
Bayboro, N.C. 28515
'�"'t`'t�
FOR�52t OIgCo7Z -G W
iM S 3 L00 3001:4 7 L60 10 S9 200 2 2 L 3

r
_.ADJACENT RIPARIAN PROPERTY OW:NER. STATEMgqT
I hereby certify that I own property tc, Lk C's
lNme of Property Owner)
iraperty located at at�
(C$9 Mock, lr .ec' �1a erg-) - _—' ,; ,i. P.
A (� n
�v, Y� f� •s 3 %awns
1�
N-ship �l4 Ns c . N. C.
(Waterbody) 9 �_ ("',awn and/or County)
o He has described to me as show bn` - �v . k 1� 7y,;lopmeat he is proposing at that location,
do
MI have to objections to his propos-J.,
QNo
DESCRIPTION AND/OR DRY..''.': Jfi " PROPOSED DEVELOPIYIENT
(To be filled in by ,:;w,�Ttl; development) ' -I, - _
G_ev✓�v�
Print or Type Name
Telephone NL!nber
irate: 19k
We-eks

ADJACENT
(FOR x r RNM STA' E ENT
Y hereby � ^ �.w,�,�,.,
certify twat I owr� —}-
T--; A,e:'V located at �P erty Owner)
(Lot, Wi&, P,"d, e ,-:>j --
Tows' "r
(Waterbody)
and/or Cov*tty)
He has described to me
�, as �►� .• •-..u , b�:.:�►r t:ie level - anon, and, I have nc, objections try SFy a `r -, development he is proposing
be set back a � I understand that a pies/uncovers bnti t;
t ?•, by me. minimum distance of v'�a�.:�; �� +'5') from My area of riparian access
I J9--nX wish to waive the
_ � I dQ wish to waive am s ` Lek r A
1
WC
DESCRIOMON AND/O� 1_ ? ` . C; gCPOSED DEVE�
�C (To be filled & 1-y a::,l �:;1. - _ I p ;.po .e F'MFF1V"C:
sang lopment)
signature
Fret cr ='ape Name : --
'll'P,� •hone Iy T