67135D - Robinson

ICAMA/❑DREDGE&FILL
3hENERAL PERMIT JJ Previouspermit# A B
lNew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
A' : ; ' ?: ��, �j 71ules attached.
t Name v - �`� ' Project Location: County E � 1'O K)
f 1 t V f ✓ n Street Address/ State Road/ Lot #(s)
State Alt ZI PZ"rLIKO
t") E-Mail.. , Subdivision
ed Agent �h C� S City ""� h `�'1% ZIP G'f'5,,1
❑ Cw ❑ Ew lq PTA Ass
s Phone # ( �"` `%River Basin A✓4 tC
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
El Pws: Adj. Wtr. Body N-•t�g J "I-CAtirrai'Yi
p�� Closest Maj. Wtr. Body ��`�' /�'/ �--A
yes (n PNA yes / no
Project/ A
ck))W,gth
Platform(s)
ngth 1
tuber
i%kiprap length i7
distance offshore
x distance offshore
cannel
)i'&prds
ID
e Lengti
not sure yes-Cno
ium: n/a yes
Yes
o
\ttached: / no
l'-v w 4 I-t PV M^
(Scale: !� j
ig permit may be required by: ❑ See note on back regarding River Basin rn
Local Planning jurisdiction)

NW Dil�`I�Jl®ll'� Of ®a.�7` 'dl .lYlgs Habitat
App6can
�I
Date:
Describe below the HABITAT disturbances for the application.
Habitat code sheet.
,AII values should match the name, and units of measurement found in your
PIRI.4L Sq.
TOTAL Feet
FIN.
TOTAL Sq: Ft.
(Applied for.
(Anticipated final
ied for.
(pistulrbance
Ant
distt
DISTURB TYPE Disturbance.total
includes any
disturbance.
Excludes any
total includes .
any anticipated
Excl
rest
Habitat Name Choose One anticipated
restoration
temp
restoration or
tem.
restoration or
and/or
t
tem irrri acts
a
;t arnoun
D fj✓
Dredge [IFill
Both [I
2 yv
Other ❑
Dredge ❑
Fill P
Both ❑
}
Other ❑ ( 2
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑.
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T� y A, am S (2. 's
(Name of Property Owner)
property located at
�1 (Addres ot, Block, Roa , etc.)
on Vic1 c.� J-� in S/1 (�� t/ , N.C.
(Waterbody) (City/T n and/or nty)
The applicant has described to me, as shown below, the development proposed at the above
location./
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner formation)
i ature
Print or Type Name
2 Co 27 L
(Adjacent Property Owner Information)
&VJ ..;I-
Signat g
(�WO ��
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I
' I have no objection to this proposal.
V I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner
Signature
A > (3 / 4/ 1L /I 0 e4
Print or Type Name
�;3i3 El r f G YI .
(Adjacent Property Owner Information)
�
Signaiuri;�'
Print or Type Name