71853D - Martin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at _� ) 3 ba K A l
�hnE:-4 Ala K.�
�(Name of Property
6 _ QtNi l i/l-A /
I
on �Uc kia j �� . (Address, LA Bl ck, Road, a a)
Waterbod ' in �� 1 ([ i t� V (A N S ui (C T N.C.
( y) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
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)
wRep��
Cqa-fib (0 6' to d Q,
Re..pai t e
lam" eA3 i 5
,'
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.)
- ish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
tgnature
16h a.4. Ma
rrtt'N
Prf or Type ame
ildpg Address
i Nc� � 1re>✓/ .0 2955 b
Cif /State/Zi
,IT#3 - 3 -21724 N-g J 7Z-2�(2 s
Telephone Number
Date-1 j v 3� � i q
(Adjac Pro ert nfor t'
Si ure L_
�a J
Print o�Typ�arne
11 U X le Ave
1ng Addre s
le �l r'. 2 k3o/
City/St ta/Sip�/1277— 70 72
Teleph N m
7 �
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to c`ftsh i> E :4 101 a K • imyTiin 's
31 baK Ave U (Nam i f Property 7. - 2
property located at
C,
on-QCkUJ6 Fo I (Address, Lo eI ck, Road,Ac.)
(Waterbody) (CitylTown 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)
--Lpawom i
h
c y loin" AJ' I S
X se
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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Poe or Info ation)
r n tune Sign�(ur
f,, I (
Pn or Type ame Pn t or Typ ame
'01 3 7 h; Ind A vP , �. D • B-d x —1
%ogA�ddress
rNA_d f re�) 9 •G 29,55 b rDr Address p
cis68302�ciryisr�;p� z-1 � 31a 1726 ./
Telephone Number JT Telephone Number
Dar JQ T
/ 3Date
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM
Name of Property Owner, U o h n Iz , a
Address of Property:
Agent's Name #:
Agent's -phone #:
(Lot or Street #, Street or Road, City 1£ County)
Mailing Address:
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.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Divislon of Coastal Management (DCbf) In
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ert,
Wilmington, NC^ 28405-3845. DCM representatives can also be contacted at [phone]. No response Is
considered the same as no objection if you have been noiltled by Certified bfall.
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 musj Initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
t do not wish to waive the 15' setback requirement.
(Property Owner Inform on)
Signature
_" a A-rmf'
Print or Type Name
&-5 -1-6r-� Ave -
Mailing Address
kin e, .0.29 56
Cif /State 1p
3y3;M-17ZIo, A3-37 Z-2UZ5
Telephone Number
Date
(Adjacent Property. caner Information)
srgnantre
0, m Ha r1's� f I
Print or Type Name
P. a, rya x '7
Mailing Address
-RIbecxF 1e , NC ZOoD 2
City/State/Zip
Telephone Number
Revised 6118/2012