69431D - Wilson

DIVISION OF COASTAL, MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORA
�Iam@ of Property Owner: J �^z � - 11
Addfoss of Property:
M -1
6k', pl( lAb0
(Lot or Street #, Street or Road, City 8(County)
Agent's Name #: Mailing Address; ��
Agent% phona 4:.—_91am, - ' -Y _ ..�_ &J � �,u� �i�. (. � PYo 3__ _—=-
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 jhe development
they are proposing. A description or drawing. with dimensions, must be orovlded with this latter.
l have no objections to this proposal. I have objections to this proposal.
if you hava objactions to what is being proposed, you must notify the Division of Coastal Management (DCM) in
wilting within 10 days of recelpt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 18408 3840. DCM representatives can also be contacted at (910) 79Q-ni& No response is
considered the some as no ob cation Nyou have been nod led by Certified Mott.
WAIVER SECTION
I understand that a pior, dock, rnooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 161 from my ,area of riparian access unless waivod by may. (if you
wish to waive the setback, you MUgL1WULI the appropriate blank below.)
k�V�I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Stg� 'ore
12 L Le
print or ryps Name
i0t Eir'tne le 1Jc�
Mailing Address
(Adjacent Property Owner Information)
5'!� nt ar► �,
Print or Type Ammo
Mailing Address
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CERTIFIED MAIL, ETU - N RECEIPT RE _ UI~_ T D
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner
Address of Property, l,Ii ei."t-F' (L Q.1ad ��r'��Ju AI ;e,4- d iau
(Lot or Street #, Street or Road, City County)
Agent's Name cl,n o C/ Mailing Address: , i, L
Agent's phone p: 9/0 -,2 -61z - S ��
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. d _s n I s ed it th` Ie t ,
)�— I have no objections to this proposal. .6 I have objections to this proposal,
if you have op/eettona to ghat is being proposed, you Must MCNy the Division of Coastal Manspamsnt (0CM) in
writing within 10 days of rocelpt of this notice. Coneapondence should be mailed to 127 Cardinal Driva Ext,,
Wilmington, NC, 204044-8 b, CCM representatives can also be contacted at (910) zoo-n1t1. No raaponse 14
consitto d the Barrio ea rrra 0b action f Loci have been notified b_ Certified Mail,
WAIVER SECTION
I understand that a pior, dock, mooring pilings, breakwater, boathouse, lift, or groin must beset
back a minimum distance of 15' from my area of riparian access unless waived by me, (if you
wish to waive the setback, you IMs. u i i l the appropriate blank below.)
1 do wish to waive the 16' setback requirement.
I do not with to waive the 151 setback requirement,
(Property Owner
)A)
Print or Typo Warne
PLI
Meiling Address
1.1 . . I - I 1 1 '12. 1 41� '0f6— .
(Adjacent Property " nor rtnation)
Print ortype Name
Mn'ling Address
r7✓l , n c1 All

0. a
Name of Property Owner Requesting Permit: sa"i0 `� S *A -
Mailing Address: 114 �kewwllL UJ -- -
Phone Number: 9 l0 - -
Email Address: w��S�^
I certify that I have authorized 'i0,17
a A_
to act on my behalf, for the purpose of applyf'ng for and obtaining all CAMA permits
necessary for the following proposed development: do � , �r III t. (
at my property located at IIw �r �et �i��Q QO VOSVIO-,
in 1,j 4' Apt-- County.
I furthermore certify that i am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands In connection with evaluating Information related to this
permit application,
Property C)wner Information:
Signature
Print or Type Nano_
3LLLL4ter.
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: U`� I y� 14r
Date:
Describe below the HA ITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount
temp impacts)
amount)
Dredge [I Fill [I Both [I Other
4J�
Dredge ❑ Fill ❑ Both ❑ Other
,z
Dredge ❑ Fill 10 Both ❑ Other ❑
�l
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑