53165D - Smith

.•`w.vlw-"iyL PERMIT
'I'New JModif'
ication ❑Complete Reissue ❑Partial Reissue Previous permit #
Date previous permit issued
rued by the State of North Carolina, Department of Environment and N u atural Resources
:oastal Resources Commission in an area of environmental concern ��jj //��
p rsuant to I5A NCAC /I"�• 2,S'�i0
1-__�i S,n ,a` h
ules attached.
11� Project Location: County�Q 4,f w f a/ ) c x
1 7 /c V. �j� State ZlP.2Y,�
Street Address/ State Road/ Lot #(s)
l
� C/ yS
/d )-��6 Fax # (—) �-r t �^�Ps ,L
d Agent yy�jul� ,4�
❑ CW ❑ EW PTA lJ Subdivision
❑ se City
❑ PTS
Crl L 7i
Pw
O PWS: HF " IH ❑ UBA ❑ N/A
❑ FC:
's no PNA
yes , ng. - Crit.Hab. yes / no
roject/ Activity
length
)rap length
rote offshore
:ante offshore
-ds
atlift
ig
. ,- s;w
h for
---------------
wre yes �} h
;ure yes
n/a yes
no
yes
C i2 cle d
S � �Ac� ZIP
Phone # (_) -
River Basin yn►�i r,
Adj. Wtr. Body
Closest Mai. Wtr. Body 9 �'�9,�� c
(Scale:
it may be required by:rsZ, 494-/ ,
Conditions e% El See note on back regarding River Basin rules.
x �i l ii'1 w l 1 - __

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: v< i
Address of Property: `C-
aovt T ,
(Lot or Street #, Street or Road)
t
- - -- - (city and County)v
I hereby certify that I own property adjacent to the above -referenced property. The individ'
applying for this permit has described to me as shown on the attached drawing the development tr
are proposing. A description or drawing, with dimensions, should be provided ,, ith this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7,
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must bE
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to waive the setback, you must initial the appropriate blank below.)
U� I do wish to waive the 1 5' setback requirement.
Sian Name
I do not wish to waive the 1 5' setback requirement.
Dat`
a11_�
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a4-
i
IL

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: / 7"J 0&,vi 7}V.,x- J C4
(Lot or Street #, Street or Road)
I
and County)
I hereby certify that I own property adjacent to the above -referenced property. The individi
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter.
t% I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7.
within 10 daps of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must bi
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 S setback requirement.
6-6
A �7' 77; VA