45788_CHEREA, ISA & GARLICK, WILLIAM_20060621

T
AMA /qDREDGE & FILL
- 1* 457 838�
GENJE AL PERMIT Previous/
permit #
:c(slew oclification DComplete Reisjue ZPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Na ral Resources
and the Coastal Resources Commission in an area of environmental concern purs ttolSANCAC
EVRules attached.
Applicant Name T:
k<_ Project Location: County
Addre
_k_32)
Street Address/ State Road/ Lot #(s)_
City j State ZIP- 15
'- ' �r, i -i ' 4�,. - � , , - - I t �� I
Phone # f mw# (94):�L (I Subdivision
Authorized Agent f_ Z I Py
Affected El Cw XEW '*TA EES El PTS Phone# River Basin
El OEA D HHF 11 lH 11 U13A El N/A
AEC(s): Adj. Wtr. Body nat. /man Junkn)
0 PWS: D FC:
ORW: yes / no PNA yes / no Crit. Hab. yes no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) lenqthLl ' , , /, l ' 0 1 _J; -1" . , I--
Platf
Fing
Ciro)
--Bulk __f
Bash
Boat
Boat
Beac
he
Shor
SAM
Sand
Mor.
Phot
Wan
A bL
f(. v
Cale:
I
)rm(s)
:r pier(s)
---. -
I-
i length
number
,Q/ Riprap length
avg distance offshoreore7
max distance. offshore
,channel
F
V
f
1 0
7­
77
-7--
_V�
4--
cubic yards
ramp
iouse/ Boatlift
i Bulldozing
-V 7
>u4
Ane Lengtl4:LXq_1� -LI
not sure yes
gags: not sure yes 0.,
torium: n1a yes 0_.,
)s: es no
ar Attached: yes no
no ).1
LL,
ilding permit may be required by: See not
on
acK reoardina River Rncin —1—
Notes/ Special Conditions ;k1;1
i 6__
Agent or Applicant Printed Name
M A
Signature ** Please read compliance statement on back of p tad URI
4
fxpiration Date

D
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to 7-%ov AS C_0' IS
(Name of Property Owner)
property located at
(Street Address, Lot., Block, Road, etc.)
on , in , N.C.
(Waterbody) (Town and/or County)
He/she.has described -to me, as shown below; the development he/she is proposing at that
location. and I have no objections to this proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(initials)
I do agree to waive the 15' setback requirement.
( (initi" als)
----------------------------------------------------------------------------------
CRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
/ M.
.. � �bi 4� L'i 01
--------------------------------------- -----------------
Signature
%vVAs, .A XCa9
Print or Type Name
/- q/9 �71; � s�
Telephone Num er
Date: � v "'

CERTIFIED MAIL --- RETURN RECEIPT REQUESTED
DIVISION OF COAST -L MANAGEI/IENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAVAIVER
FORM
Name of individual a >I lying forI ermit;-. W'0-
I - --
Address of property: Z!C®
(!or or street .1, street or road)
!—rl-04"e l
(City & cour,ry>
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described tome (as shown on the attached
drawing) the development they are proposing. A description or drawing, with
dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have.objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
within IO days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand.that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags
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.)
*'f . -,2L I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
.7 l (o�
Signature LFate
Print Name
1 33("1 a SC),
Telephone Number With Axea Code

MpRY Y O sco , SR
DR NC 85;
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4561
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