69129D - Griffie

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5/15/2017 1 1 G.H. Griffie Jr Chuck Griffie I BB&T 13443 $400.00 GP 69129D

41C Division of Coastal Mgt. Habitat ImPaCt Computer Sheet
PPlicant: f v Permit #:
C� C�
)ate:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
`ound in your Habitat code sheet.
iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/oi
temp impact
amount)
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ( Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
.
Dredge ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 6. H . a:-.) ci
Address of Property:
S
(Lot or Street #, Street or Road, City & County)
Agent's Name #: N Mailing Address: n/ A
Agent's phone #:
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 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 [phone]. 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr9p9rty O reformation)
Sign lure U
G A if z:J
Print or Tyke Name
510+ (-k'ct Ae rl v t L Li RJ
Mailing Address
(Adjacent Property Owner Information)
�1�/�7
Signature
Print or Type Name
Mailing Address
,:;og
l_„- _ — ,- I- - n I , - - -

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify ;iiat I coon property aid atcnt to C-,_ • H 4. Li � d L • G--c V 4-i 2__-
(Name of Pr perty Owner)
rest, t:icnt an 3 ad .R ,� mot- va vJ SW �s �$'
(Address, Lot, Block, Road, etc.t
VV ii. $ u—��r i K.C. t+.,vts w C
{Waterbodyf 1 lTown andoir County)
The apniscant has eescriGed to me, as shown below, the deveiopr rent piaposed at the atoti,e Iccat=on.
have n- nbiiection tc% 1'7is proposal_
I t-ave oh edions to this proposal
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
,`Individual proposing development must rill in description below or attach a site drawing)
Rip Rap installation per attached drawing upon
approval of CAMA permit.
WAIVER SECTION
understand that a pier, d,: k; mcorir+y piiii :4s, h eakwater, boatho.aso, lift, or gro4n must 1_+a set tack a
mini nliltl''! distance of 15` "T-in my a.ea C; ripar-,an a, -Coss on'*!ss -wai ed by mo. (1' you r4is,11 tC: '/J3iV
the satbaci . yoi: must initial t';e approrr'ate b.ar,�, below.
dO WV SI' to -.vaiva lhe � `, SL-tbiack regwrr^ier;
I do not ilizh to 'waive the i 5' setback re-cuirement.
(Property Owner Information)
(Adjacent Property Owner Information',
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