69381D - Wagstaff

XJGAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit #
XNew -'Modification -]Complete Reissue 'Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources /� //
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC o4T( t Z iX )
0 Rules attach.
nt Name W Qr
Project Location: County c,
s 3`7 3(91Street
Address/ State Road/ Lot #(s) '�—
(4V\ d State AX ZIR
# (511) ZW- 407 7 E-Mail
Subdivision
ized Agent (1 taY1:� )+1 64
City 'i zip---'
❑ CW XEW ❑ PTA ❑ ES ❑ PTS
Phone # ( ) — '" River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body 00, je&
❑ PWS:
yes / no PNA yes / ®o
�• -Stow
0
Closest Maj. Wtr. Body'?`ttii`,J
>f Project/ Activity
I
ock) length 1K
'latform(s) "
g Platform(s) I(p C 1-
ength
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards_
imp
Ouse/ Boatlift
MEN
IiFAF MEN MEM
(Scale: I =
❑ See note on back regarding River Basin

DIVISION OF COASTAL MaNAGENr NT
` ADJACENT RIPARIAN PROPERTY 0 R NOTIFICATIONAVAIVERFQRM
Name of Individual Applying For Permit: Q0� L"S`L)91
Address of Property: `
•Cs� 1�
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -reference ' -property. The indivi,
applying for this permit has described tome as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lette
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co,,
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-;
within 10 days of receipt of this notice. No response is considered the same as no objecti,
you have been notified by Certified Mail.
—� - WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu;
set bck a minimum distance of 15, from my area of riparian access - unless waived by me
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
T-
I d2 of wisl+ to wraive the 15' setback requirement.
Sign Name

I*
ANA4 L—
CERTIFIED MAIL. - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACTNT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:
1 Aiqr(oQ-1 1\
3o 4- ors 1,P
(�,, (Lot or Street #,Street or Road, City &County)
Applicant's phone #: gl�-� - (Q ? i Mailing Address: _ _
1-)V
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
has described to me as shown on the attached drawing the development they are proposing. A descri tion of di
with dimensions, must be provided with this letter.
l/ 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 (l
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Dri
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No respons
considered the same as no objection if You have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, clock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum dist
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial
appropriate blank below.)
I do wish to waive the 15' set back requirement.
_ I do not wish to waive the 15' set back requirement.
(Property Owner Information)
wlor,vy� 6�aex,
Signat re
(Ri arian Property Owner Information;
�gnature
/�s S�Izc guar d s
Print or Type Name Print or Type Name
�fz f g601 r 1744 ZS lati �_
Mailing Address Mailing Address
27��i�

North Carolina Depc-14,neot 'j,' Environment and, Na!,
DNislocin (). :;oastal marlagenieril
C. Dovis Jc tin ::^. sk,iada, HI
Director sec—Iary.
Jww's Waiiiiiii Addis.
Date:
Na oe r-* �-Ujn rjj,� Ar �lvjf r,iis , Dr j
Age. VW pg / C.,
N kc-1-9S.S:
Phone Number
ceft,ty that I have authorized the agent listed atiove4 to act on my behalf, fc, the Pulp 0i Cif
4i *a tx'ning all CAPM Vermi'B reG'f!SSaOI to ,stall or construct tne fol!oong (ocbvitylr
or my prope(ty iocared m
is valid thru (date). . ......
- Pro Date