Turner Jr, Kirby

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tok gg�q pb,4hViL."e, pmr—
(Name of Property Owner)
property located at e4,;�k ,
(Lot, BIock, .Road, etc.)
on N", lDDrNS Le k , in �:5WI XNA N.C.
(Waterbody) (Town and/or County)
AppIicant's phone dli ? ( Mailing Address:!,., 3�r�
He has described to* me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
1
------------------- _---' ---' - -�-c------�-'-`--- ------------------------------------------------
(Information for Property Ow er A plying (Riparian Property Owner Information)
for Permit)
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Mailing Address Signature
City/State/Zip
Telephone Number
Signature Date
Print or Type Name
Telephone Number
Date