71852D - Deal

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9G�frT AtfTHOR17,41T'QN FOR LAMA Qf gVIT APPI ICATIO[►_
Al Name of Property Owner ',eques" Pit.—� nC- A �-
t' Manic . AddrOSS
t.me Number—
Em&I Mdtez: tw C. c{ ea.1 0 clv,-t k (. CO
f oertdy that I nave wuthortzed �►[ i 1 LoU [ TAMI ,mnhr_(A c -
Aga•t r Cor asra
to ac' on ttty beliar. for ;F,e pwpase of appip.ng for and o&.a nin9 a3 C�AMA permits
rmoe°,eery for rho fat:owtnp proposed deyetppment/�1�C-i--
at my prcperly Iocateo at'-":Y4,Gf4T 01� I L ' SLA1`: �
to �ItA t.. Comity.
! fuzThemtom ceztily !!:af f am aul; ronzed to grant end do it tad prarK P0424* Sion b
lovisron of Cossfal !4anagernunl staff the Local Pam* Off ow ar)d !heir agents to W*r
on tars eforemar!ared lards m ccnneclion wdh "B.bafrV '�rWorr mdbn rebfed to N*
pamul applrabor
Property Owne r I rtr
S1D^attrMe
Frill or Typo Mama t
Pro p"J- L-(
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not
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CERTIFIED MAIL • R.�TIJRN RECEIPT REQUEST D
DIVISION OF COASTAL MANAGEKENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNlAIVER FORM
Nanw w. of ProY Owle' _ Daug ..1�a.1 --- ri of c: Sr a.w v. S:w! or Road. ON A COLA*
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Arlen: s Nsats S. C�t1L].L i��— u i.,v Address i "'-S
Agents G�ora t. ql0-;La-Cug0 SO L ' —
I I:areby car* VW t oan prop,):* a ipa rt to ttta sboMa m!eron ed proQerty. The ineiv:Cua!
appWq for to pwn* hart deathbed to me as SW Mt On the sttad'Md devebprr e'*
tt+gr aw A daaufoport or waana. �wMt tlYrtsffaiorta m,�St bs rxtWided wit!t tivs relter-
I hnc nt ohjicliunc to thi: pmptr,a:. I h nc n},r,c�lrms in hi< FxnFtusal.
r! rev hary objecriorn to aMl b b" proposed, you M.vs t rnt ry rho OJ LNon Of Co+snr Lsnageme rf� l�Iic�Ki A-1
w•:; r.p m A� r,7 days of rocoV or rhn nc:ice. CMtst.PCn+c.lce s-f)*Ufd bo mm�ed to f27 CarditW Vrr�e Eat,
:Y':m.+sgron, NC.:8s)S.TI{S. !?CM repres�resnrro ua sa � Os corLc:ed st •5f0i 796-7215. Ho response Js
C--0l4rod rho to—. so np 0t cNon rr yvu Pars boon rot :red by Cerrrf,.4 U49.
WAIVER SECTION
I t.ndv sand that a W. doc;- mooring ptnngs, Creakwa:er. Doa:hCada• 4. Or groin mus: be set
back a rrtrtitrerrn datance of 15' frorr my atop of rpatian access urftn vwied by me (If ycu
Wish to traive the setback, you 1uf t initial Ina aopropnato clank blow.)
I Lic Lmsn to Lave t:•e • SOtba4. rerutrerner.'..
do not wish to worse the IS' setback mQuiremont
( Ormer Info j
,�'iti alto.
R'Inf (Y T Jpc Nano
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Addrer
TeAV)am AAtmbcr
informabonl
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WntorIMa Name
MovkV A,tdrabd
Rio • f'v70�f3
TNaphono mimbe,
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ADJACENT RIPARIAN PROPFary OwNFR STATEMENT
hereby Certrtrr Mal! 1 own property adjacent to 's
ropertY r) 1
p(oWy located at 61-C'HT �2 I �•t �- {t__1�_!-'' t • _—
(Address. U)k toc� k. Road etc.) N.0
Ott �,V.J . In _ O U'T
(Waterbody) (cttyrrown andlor County)
The aF I.cart has doscrlbed to me. as shown below, the development F cgosed -, the above �!•o
! have no oblecWn to this proposal.
I have Obiectbns to the pryPoeal
DESCRIPTION ANDlOR DRAWING OF PRCPOSED DEVELOPMENT
iindividual proposing development must fill in description below or attach a site dr&wirrg)
wAIIVER SECTION
I understand Ural a per, dock, moving p4rigs, breakwater, boatnotse, lir, or gran must be set bac
Tr:nimu'n distance of 15' from my area of panar access un!eu waived by me (If you wish to vr.
Jte setback, you must Initial the apxoprate blank be:aw.)
V I do Nish to waive tP.0 15' setback requirement.
I do not •ti•,sh to wa r)e the 1 b' setback regt:.rement_
lv T / "4z
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T Number
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(Adjacent/Propery Qwnar Intormation)
s,�t, L�r:A
Past or r,pe tame
3�66 E
Marirsq Address
C'r,,'Sa:afup q IU - �'� q• Z y j �-
Te'etr".one N 9er
Date