69015D - Wiles

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ENERAL PERMIT Previous permit #
New _Modification EComplete Reissue ElPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC O.V7.1200
E] Rules attached.
t Name I'f S Project Location: County grx*Nst" ic't
zol S4. Street Address/ State Road/ Lot #(s)
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g permit may be required by:. .6 n 1
u El See note on back regarding River Basin r
ocal Planning jurisdiction), . I . I

/ DREDGE i FILL
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4:E7NRA1. PERMIT - � � � Preview permit #_.�..._
:Modif►cation Ocorrtpilete Pwkrjk�i� Dace previous permit issued
As at wrtzed by the State of North Carobv. wed NWW Resources
and the Cosnni Resources Coenraslon in an area Of QP fpn(�rq � to I SA NCAC Okau ......
�noci.
Applicant NarnlsW __ _ Prooct Locwdow County &Vv►31,` Lt
Addr+ass 20 3 S 1 ' S�. Sam Address/ State Road/ lot 0(s)
Phone # (2a?) /2411 Subdivision__
Authorized Agent
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Wxhw Attached
A b uiidol perrntt may be required by: (% L -TS k o, * Sae note on back regarding River Ras
( Note Local Plvxung)urtsdkd w){� �
Notes/ Special Conclitions K..1i 07H. ago d.+nrf�no 'KC14^r�.� r s��� Qom, rl (t Jacq f (le 4e t&4fo^,°.
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ADJACENT RIPARIAN PROPERTY OWNER /STATEMENT
I hereby certify that I own property adjacent to � ,q-s M !/1a'yh � s
(Na a of Property Owner)
property located at Z S 1.1 l S - -h �7,
on _ L j1`�/� !/A�!`S (Address, Lot, to k, Road, etc.
(Waterbody) In (City/Town nd/or County) N.C.
The applicant has described to me, as shown below, the development proposed at the above locatior
Yes 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 waiv,
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)
Q
Si ature
Print or Type Name
(Adjace t Property Own formation)
ignature
�
Print or Type Name
2os sGv [ :!� f-h sI.

vn Receipt Qtardcop-,t) s
,m Receipt Idecmdc) S
Wed Mail Rest&led Delivery $
t Signature Required s
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iplete items 1, 2, and 3.
t your name and address on the reverse
nat we can return the card to you.
ch this card to the back of the maiipiece,
n the front if space permits.
le Addressed to:
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A. Signature ,¢
X ❑ Agent
❑ Addressee
B. Received by (Printed e) C. ate 0 Delivery
D. Is delivery address different from Rem 1?' U Yes
If YES, enter delivery address below: ❑ No
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❑ Pdo ty Mail Express®
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Restricted Delivery
❑ Reeglsteedd Mail estricted
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i 90 9402 1488 5329 0172 19
Q CaMfied Matf Restrfcted Deffvery
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Merchandise
e Number MpasfeLffp/L1 �VJm- label)
❑ Collect on Delivery Restricted Delivery ❑ Signature Confir n itlonTM
nsured Mall
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5 1520 0002 2209 9926
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Restricted Delivery
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-n 3811, July 2015 PSN 7530-02-000-9053
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Postage &'Fees Paid
USPS
I lull all 11111111111 Permit No. G-10
9590 9402 1488 5329 0172 19
United States I • Sender. Pleaca nrint

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