63170D - Motts

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MOTTS CHANNEL SEAFOOD
120 SHORT ST. PH. [phone]
WRIGHTSVILLE BEACH, NC 28480
PAY TO THE �y ;�"f' 1t
ORDER OF
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66-30/531
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ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name
DISTURB TYPE
Choose One
TOTAL 5q. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance_
Excludes any
restoration
and/or temp
impactamount)temp
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Dredge ❑
Fill ❑
Fill ❑
Both ❑
Both ❑
Other ❑
Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6Q s
1 (Name of Propertycaner)
property located at ��� � ��)
�f (Address, Lot, Block, Road, )
on�T/ C/1� in N.C.
(Waterbody) (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)
;6k
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 we- to -Vavq
the setback, you must initial the appropriate blank below.) pCM WILMINGTQN
I do wish to waive the 15' setback requirement. MAR p 5 2014
I do not wish to waive the 15' setback requirement.
property Owner Informati
Signature
ae
Print or Tie Name /
fir' ,n
(Adjacent Property Owner Information)
Si O ure l -
Paor e Name

s
24
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RECEIVED
DCM WILMINGTON, N
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to n ' Z& rD(� s
Name of Property Owner)
property located at !� i l�✓?!
(Address, Lot, Block Road, etc.)
on ��� C� ��P in -. /�,�� N.C.
(W t rea body) (Citffown and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
(A 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)
;2
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.) r-t, C E I V E D
WILMINGTON,
I do wish to waive the 15' setback requirement.
MAR 0 5 2014
I do not wish to waive the 15' setback requirement.
nor Inform (Adjacent Property Owner Information)
Signat e y� Signature Z
Print or Type NgTe 0 Print or Type Name

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