12099_ROBERSON, EVERETT_19940204

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CAMA AND DREDGE AND FILL
GENERAL ° 10199
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 15 NCAC
Applicant Name l` t `' Phone Number --
AAA
ress i
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity J
State
Zip
PROJECT DESCRIPTION SKETCH (SCALE:
Pier (dock) length
Groin length
V _
number._.,_.. --
Bulkhead length
i
max. distance offshore
Basin, channel dimensions
cubic yards _.i i �� r
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,
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'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 e <,
objections to the proposed work. attachments i
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

GRAFTON MARINE CONSTRUCTION 66-85/531 537
105 SEAHORSE DR. PH. 919-393-6137
SWANSBORO, NC 28584
PAY TO THE �Z ly�
ORDER OF
L-L A R S
Centura Bank.
Cape Canrm, NC 28581
MEMO�C 12SC�N
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
( FOR A )
I hereby certify thk±--7�own property adjacent to
Name
's property
located at 0" "4- , on
�+ (Lot, Block, Road, etc.)
, N.C.
(Water Body) (Town and/or 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. I understand that a pier must be set back a minimum
distance of fifteen feet (15') from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Signature
I/tiGt'�o
Name
Ph no e Number