Exempted_Weeks, George_19940926

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to /`�� .,� �'� 's
(Name of Property Owner)
property located at 3 �' e-A
(Lot, Block, oad, etc.)
on w,. �•-e- `,,- , N.C.
(Waterbody) (Town and/or C unty)
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/uncovered boat lift
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 the setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTTON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fill in by
individual pro$osing development)
Signature
IPrint or Type Name
Telephone Number
Date: S f h�
I
I

Jr
I hereby certify that I own property adjacent to ",L.-if--, W 's
a(Name of Propert JO ner)
property located at
(Lot, Block, Road, etc.)
l
on 1g2d 0,,t , in ' , N.C.
(Waterbody) (Town and/orCounty)
ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT
(FOR A PIERIUNCOVERED BOAT LIF7)
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/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
�t I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
6
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(T {eed VfiLindi>id ProPgpfng development)
X
i
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lSignature
Print or Type Name
Telephone Number
Date:`' ✓ %%