66368D - Price

ICAMA / ❑.: DREDGE &•FILL�`'
3ENE L PERMIT � ` 3 � 1b Previous permit # �� 4
]New L7ification ❑Complete Reissue ❑Partial Reissue Date previous permit issued l
rized by the State of North Carolina, Department of Environment and Natural Resources 0�" 7
: , 1
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC '/
OMles attached.
t N [ e " ( � HH-� �/` + Project Location: County /`,1f. �
0 • aox n) % Street Address/ State Road/ Lot #(s)
V!'J
K,' State/VL ZIP
,� f v�
( i') � �" E-Mail b�i"n ri':- ee• r�''.lG� Subdivision
:edAgent TOJ.� %rj1'�tll.-� City !�►�% �'�'1//7tf/�'h ZIP
Otw PTA ❑ ES ❑ Pls Phone # Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body w �1f�t �i'f'l% h
„ono i PPJA ,C V i — 1 Y
Closest Ma Wtr. Body
1`�'SC1M JG✓U �/>
f Project/ Activity
length `
ium: n/a yes & t
ye no
kttached: yes 0
ng permit may be required by:
Local Planning Jurisdiction)
❑ See note on back regarding River Basin n

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to_ ) QV► d �! QNW �V I (� s
' t M
e of Property Owner)
property located at "1 l� VIUCCQN Q�
�L(Address, Lot, Block, Road, etc.)
on �QW�Q,Cr S CrQf��L ,in Wi1M',NG IOAJ ,N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc do .
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)
RECI iVE-- L-
DCM WILMINGTON, NC
1A AR 1 7 2016
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.
(Pro erty Owne formation) (Adjacent Property O �ier Information)
Signature cc -Signature *�
Su�-aNr� � �✓�
Print or Typ,�j Na e Print or Type Name /'
T . � . po �i Q i �l / . 5 GI c t z--
�I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to "I )avid JaAz) �� LA IUNr�r_1 ma's
n(Name of Property Owner)
property located at Li uC( (�-/yC�t� rid
ll - (Address, Lot, Block„ Rogd, etc.)
ontWl2,- _ite.i� in tN, (MIA( (,-Toth 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)
RECENED
DCM WILMINGTON, NC
MAR 1 7 2016
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. (Jf 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. cry+_ %
J
(Pro erty Owner rmation)
S411tilre
Print or T e Name
• o . goX 4y0
(Adjacent Property Owner Information)
Sl �r1Ll/1U'C *
Z,1
Priin71t or Type_Name
-2- 13C J C__— ck,#I 0 -i

I

Basic MapTY,"bri, It",
nt