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Home My WebLink About72260D - Potter■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: n 2�0 or NC- 26 � I iri 111111111111111111111111 9590 9402 3542 7305 6932 10 2. Article Number (transfer from service label) A. Signature X ❑ Agent ❑ Addressee B. Received by (Printed Name) C. Date of Delivery I I D. Is delivery address different from item 1? ❑Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Expresso O Adult Signature ❑ Registered Mail - El Adult Signature Restricted Delivery ❑ Registered Mail Restricted ❑ Certified Mail® Delivery ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery El Signature Confirmation"" — - - 0 Signature Confirmation 7 017 1450 0000 4344 5261 tricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: NIA �f� � 1�i �1 11► ► 11� 1 I �i 111�11 �1 � 9590 9402 3542 7305 6932 27 2. Article Number (Transfer from service label) A. Sig tune ❑ Agent �� Addressee B. Ry6eived by (Printed Nj ) I I C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Adult Signature ❑ Adult Signature Restricted Delivery ❑ Certified Mail® O Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery 7 017 1450 0000 4344 5247 Restricted Delivery : PS Form 3811, July 2015 PSN 7530-02-000-9053 ❑ Priority Mail Express(D ❑ Registered MaiIT" O Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise ❑ Signature Confirmation- ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: e lam' Ya C L' - - , , -� t^, (Lot orStreet#, Street or Road, City & County) Agent's Name #: � >z '" Mailin Address: 1315 &0-1A^ Agent's phone #: `> -� J �r%Qt��% , pry ti'C_ ae /J I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. q�E C- ✓ 1 have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405.3845. DCM representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, 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. (Pro caner Information) Signat e Print or Type Name (Adjacent Property Owner Information) Signature v Li Print or Type Name j l S �p°c nc� Iz� � (� 4 N (4o c,�,� e t Mailing Address Mailing Address 4-�I_L City/State2ip I City/State/Zip qlo g5'7S2Z� CiI� -L(t -(,G 5GLt /AIL �(77 7�r Telephone Number Telephone Number Dale- - --- - --- Date ---------- Revised 611812012 0 R<)L--r► A:Pe)I-Ek C IS U, t,) �Xo ,3 Q UE Zr rl ST Tv Gor�STIR �� arc tarn �xIST 1'(,cl �U (✓,� hPdC� �,� C. i � t C7 '� Ewer- r, P La �s t r� ' ► ►• Pt,a cis T!N fXlS Ld� /V o j/Y)a d`5h � R�5 � � �a cLa ��i u�drer� Lu C� �'� aT ��r a LL L(c 7-� a Loyd �T_ Ql v L5 ooT 2 c� 1. � p •7b 1 C Date Received Dab D osfted Check From Name Name o/ Pomk Holder Vendor Check Number Check amount Permit NumbwlComments_ Receipt or Refund/Reallocated Columns Cokum2 COIu 3 Cok rm4 Cokum5 Column8 Column? Column8 Column9 11/21/2018 11/21/2018 Robert A and Jeanne_ B Crabtree Potter Donnie Potter State Employees Credit Union 2336 $ 200.00 GP #72260D _ GP 972294D Tmac rct. 7427 Tmac rct. CLTMC Inc Brian Shu art First Citizens BanK 111 $ 400.00