59124D - Rountree

'CA1VLdi(/ DREDGE & FILL
631ENERAL PERMIT Previous permit#
]New 'Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
it Name Project Location: County 'J-C t V �1 ', + 1 C ; , 1
y� , LWk i> Street Address/ State Road/ Lot #(s)
State_ ZIP
Fax # ( f-_
Agent
CW _ EW 'PTA ES - PTS
OEA HHF - IH = UBA ❑ N/A
PWS: ❑ FC:
yes / no PNA yes /(�) Crit.Hab. yes / no
Subdivision
City--( bl l4 04 F--eCt(k ZIP
Phone # ( ) River Basin N,�.
Adj. Wtr. Body ` �''(- ` , t 'V l ^ at
Closest Maj. Wtr. Body
f Project/ Activity -1 i i tL t i.i !-I, I
camber
Bad/ Riprap length_
tvg distance offshore
nax distance offshore
channel
:ubic yards
Bulldozing
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A A,- 1C , g �,� �'f r.c ."- I
(Name of Property Owner)
property located at DbS t.�1af�,y e P lac c Cr,o ; ..y ta�41 IV((
on
(Waterbody)
(Address, Lot, Block, Road, etc.) +
in llep-cj� , N.C.
(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)
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.)
I do wish to waive the 15' setback requirement,
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sipppppp at'uK /re
I(, f If ///�
.b.L .&
Print or Type Name
0 °) at o f,-e 6' "o Co K •f
Owner Information)
-
Sig--)A,,id '�{►��SL evs�
Print or Type Type Name
l t0-7 t7K)�P✓ 1 c w ��4C�
Mailing Address
Mai�qg Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: / V 6 a r
Address of Property: Lo uJa +er �; e , p i , (AL/0 I ;
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
L 2 Lh,2
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,
p_C 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.)
yam:::� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement,
(Property owne formation)
Signature
/04rk n l r-e
Print or Type Name
Mailing Address
/ n , , , , h Air 7 rl U
(Adjacent Property Owner Information)
Signature
Print or Type Name
Son HA r Onou
Mailing Address
t , - . I „ -— • I I /-,l • - 1 1--7or-7

oepk
13 ,,1 K k e.
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