69315D - Midgett

�--AkfIA / '� DREDGE & FILL
aENERAL PERMIT
kNew ❑ Modification f Complete Reissue
❑Partial Reissue
A B
Previous permit #
Date previous permit issued t___
•ized by the State of North Carolina, Department of Environment and Natural Resources rrll
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC D-7 �' V
EJ
C lule
t Name n V\ M i Project Location: County �✓ fl W
Street Address/ S�)te Road/ Lot #(s)
State ZIP © C (t1
r�° S;(E-Mail Subdiyi ion
Bd Agent fY) /
❑ CW NEW ❑ PTA VIES ❑ PTS
❑ OEA ❑ HHF ❑ IH /❑0U' BA ❑ N/A
❑ PWS:
yes Cy' PNA yes /CO
Project/ Activity
V
City P.(�S �N% ZIP Z K�
v"
Phone # B' er Basin
Adj. Wtr. Body N tW (nat r
Closest Maj. Wtr. Body N -aA)
� t
(Scale: I I
:k) gth
Length
r iIL-
not sure yes ' now
yes 1, no
ttached: es no
ig permit may be required by: i
.ocal Planning jurisdiction)-`

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -T6 NW-1 Al ° b i e t7L-s
J,�'�' (Name of Property Owner)
property located at _ Ii /
(Address, Lot, Block, Road, etc.)
on �e+� ��J�'' in S)JO-A S Y r -
N.C.
(Waterbody) (CitylTow and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatio
' 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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wai+
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.
(Property Owner Information)
(Adjacent Property
S r r t M e- Li .
Pa©y "a
Information)
rIV1Yt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J 7XW n 6- / 's
( ame of Property Owner)
property located at f l / P� W� `
Address, Lot, lock, Roo,
)
on iy%L k R' J c✓ in ,0 M'�t t I , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loc,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawir,
-fa l
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
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.
(Property Owner Information) (Adjacent Propep Owner Information)