Not Given_Lewis, Jesse E_19951113

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/B0A7ZIFr1B0A7710USE)
I hereby certify that I own property adjacent to . �UC k;. Ixuxyi 74 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
C
on BROAD C RQ�< , in 92ig2l L A bTT�— , N.C.
(Waterbody) (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/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. @l_l..M71
Ido not wish to waive the setback requirement. '
I da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
STew{ W S ochJ
Print or Type Name
w) --76-74
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT � ^ 2 r � -�
• (FOR A PIERIMOORING PILINGSIBOATUFTIBOATMOUSE) a�
I hereby certify that I own property adjacent to 4. 4,QJA:rt. 's
(Name of Property Owner)
property located at J 44 go L L?OG W (XD _DID . t4 rho ar ? a ,
(Lot, Block, Road, etc.)
on _$ReOD 0,R6EK , in GA RTG-R E 1 - , N.C.
(Waterbody) (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/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 do not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(!,p4 P 4 L 3 a
b o 0 0 Q C� o v o o o� �� a�
Pj o o, 0 �5 _
GffE Its
A
l06 L -�
Signature
L j-'
Print or Type Name
"1(9 2,14-7 S90V
Telephone Number
Date: ILI l