13816_ROBINSON, EUGENE_19940920

fi t-
CAMA AND DREDGE AND FILL to .t/ 1 y'
GENERALr L
PERMIT
�d
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resour s ommission
in an area of environmental concern pursuant to 15A NCAC
r --
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity.
Phone Number ' )� `'/ 24
State A%` Zip .96,5 7
•s,
r , Xi, III- e-, sd r,VI
T'
PROJECT DESCRIPTION
lengthPier (dock)
r
Groin length
number
MEN
MEMO
ON
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.
applicant's signature
w
permit officer's signature
issuing date expiration date
attachments - - F1 /✓0V
In issuing this permit the State of North Carolina certifies that t
this project is consistent with the North Carolina Coastal application fee C
Management Program.

�u ene 7. �p6w
inson
_^ ^ahanne E. Robinson
343
66-30lSJ1
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at L.OT -*G3 W�-//7-Akt=- R 'PO /A)7 f'Q,O
lot, block, road, etc.
on in d 12 7-A L.
body of water town
North Carolina in 7W_!O County. The proposal has been described to me
as show -a i low- Ghe de,ielcipment, a /b llthea /StrUCtllie, a71d file proposed
(circle one)!
location, and I have no objections to the proposal. I understand that if the
development is a pier, it must be set back a minimum distance of 15 feet from
my area of riparian access unless waived by me. I do do not wish to waive
--fiFircle one)
that setback requirement.
Description and/or drawing of proposed development: Indicate the size and
location oC the structure and the distance between each property line and
the water.
11
(original must be retained in the inspections department)
— (signature�and date-
name please print

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
r
(lot, block, road, etc.
on in O�iC-A/T/�I.
body o water town
North Carolina in l County. The proposal has been described to me
as shown below; the development,a pier/bulkhead/structure, and the proposed
—circle one
location, and I have no objections to the proposal. I understand that if the
development is a pier, it must be set back a minimum distance of 15 feet from
my area of riparian access unless waived by me. d do not wish to waive
circle one)
that setback requirement.
Description and/or drawing of proposed development: Indicate the size and
location of the structure and the distance between each property line and
the water.
(original must be retained in the inspections department)
LYc�
signature and datVY
—S rzzo
please print