HomeMy WebLinkAboutNorris, WilburL
-Gt.,aMA / ❑ DREDGE & FILL No. 75737 A B �C : D
�E,NERAL PERMIT Previous permit#
�tIeW ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As autgsized bythe State of North Carolina, Department of Environmental Quality j
and the Coastal Resources Commission in an area o environmental concern pursuant to I SA NCAC Rulp-
/,
/� ❑ attached.
Applicant Name / " f fProject Location: County
Address J '-U 00 G' + ! Street Address/ State Road/ d/ Lot/#(s)
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AEC(s):
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❑ IH
❑ UBA ❑ WA
❑ PWS:
ORW: yes /(no"I,
PNA
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l
no
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A building permit may be required by: _
( Note Local Planning Jurisdiction) \
Notes/ Special Conditions �Ld
Agent or Applicant Printed Name
❑ See note on back regarding River Basin rules.
fl;nf.
PermitOffice7 rinted Name
Signature "Please read compliance statement on back of permit"
i
Application Fee(s)
Check #
Signatur
IssuingDate E piration D'pte
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ' /0 47— Cw /1,/ I
(Name of Property Owner)
property located at / 30 � 2 to • k", /7-j S 6k/'Q 6Y,
(Address, Lot, Block, Road, etc.)
on Gc/�,t-r 0,41< %?r•.�r in Su 6 sho,e 0. 516 i Cow/i. , N.C.
(Waterbody) (City/Town and/or County)
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 Information)
Signature
Print or Tvpe Name
/email address
(A 'acent roperty Qwner o ation)
*nature*
,/u.,o Qs/3Ci,t-H�/,i C 6 a
Print or Type Name
2!G/ n//-u2 li'/
Mailing Address
City/State/Zip
/ Telephone Number/email address
2-/V-/q,
Date*
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to G ya �/� 64 4- S
(Name of Property Owner)
property located at / 5 8 /J/z �o•��yf J��/ Swp -,s dau«; nJ IL
(Address, Lot, Block, Road, etc.)
on G/�,fC VIA;I %Z+�e> inN.C.
(Waterbody) (Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc�tipn.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
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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.)
1 do wish to waive the 15' setback requirement.
e the 15' setback requirement. y ' 7WS
L-L--I--
do not wish to waiv
(Property Owner Information)
Shenature 4/,16,r,124a-1.. "or-s .
2 - /V-/ I ,
Date
(Adjacent Property Owner inWrmaaon)
Signature' f r ✓' �!� `3(d
Print or Type Name
Mailing Address PSO
a t✓
J '.n.>ri+r5 CiGrL
City/State2ip
Telephone Number/email address
Date*
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