76555D - Lopez

ICAMA / ❑ DREDGE & FILL
aENEPtAL PERMIT
',New Modification El Complete Reissue ❑Partial Reissue
N° 76555 A
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environmental Quality 0� � ' Z O 0
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
B
❑ Rules a hed.
Name 6-A%O N% U fp c Z--- Project Location: County
S PrT I N-50 N Street Address/ State Road/ Lot #(s)
r vCA V, State14C— ZIP2��
.,)%3'6 ^ fi E-Mail Subdivision
ad Agent N / I-,-
❑ CW �E rnTA ❑ ES ❑ PTS
❑ OEA ❑ HHF It IH ❑ USA ❑ N/A
❑ PWS:
yes / > PNA yes JJ5>
City � L (Aial ZIP
Phone # ( T-- River Basin LAI D
Adj. Wtr. Body kI L- !-�20UN� (�dtffn
Closest Maj. Wtr. Body
Project/ Activity (N �c i� L lr ��T- 5 k -1 \ ���� p N l o A--T S .
(Scale: 1I -
:k) length
itform(s) N,
1 J-I I I I I k I i I i_ V
igth
nber
I/ Riprap length
distance offshore
distance offshore
iic
ip
se/ Boatlih
Length d
not sure yes �o
ium: n/a yes
yes '°
lttached:
ig permit may be required by: V f P, ❑ See note on back regarding River Basin rt
-ocal Plannin¢ lurisdiction)

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AD�I_ ACENT RIPARIAN PROPERTY Q�IVIVNgR STATEMENT
I hereby certify that 1 own property adjacent to Gaston Lopez Is
property touted at 1 — 1t .L7Mr1.�9t1 Qd (Name of Property Owner)
(Address, Lot, Mock, Road, etc.)
01,
C'
(Waterbody) In (City/Town s dior County)TlIf N D
applicant has described to me, as shown below, the development proposed at the above location.
I have no objection tc 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 drawfng)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 16 from my area of riparian access unless waived by me. (if you wish to waive
th 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) (Ad ant Property r Information)
i
Si lure Si ur -/
PrW or Type Nara Print Name
1 1 5 t►a 1 Z�Rhsa� Rai
Ma Address Address -
S r°, �, ,,
cq��sra�te� cay�sre �

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up9 a,� ti. ;t� ,�,��► oak. P'la.k -TAeAsio,
• z not- O � n'l"Nk 51GiP (or4"b+ a)
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Deck NoJ5
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Pak•1q 1

ADJACENT RIPARIAN PROPE/R�'TY OWNER STATEMENT
I hereby oertify that I own property w4acent to ("74&
a
perty ocated at "� �j (Name of Property Owner)
pro
A4k-,". 0.5
G 7 C W (Address. Lac,
(Wsterbody) in
County)
N.0
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.
DESCRWFM AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Inclivldual Proposing development must fin in description below or Attach a site drawing)
WAVIER SECTION
i understend that a pier, dock, rrimog Wings, breakwater, boathouse, lift, or groin must be set bock 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.)
do wish to waive the 15` Setback requirement
i do not wish to waive the 15 setback regLnrernent
(AdJacent r information)
ti 4 Q5 .n
PmIt or Typed N&MO
1 7 1 ? Oka len led,
MB linQ AdarRSS _.______.
.NC._ �4ti4S

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at _ 1 ��J (��-1�;��d
on l cw (Anr'k (Address, Lot, Block, Road, etc.)
In "4,- , N.C.
(Waterbody) (Clty/Town d/or County)
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
th 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) (Ad ent Property r Information)
Si nalure Si tur
C-iaskon L-00e (��a SF+<c4P
Print or Type Name Print or-�ype Name
/ -75 4)-k;►,s0'1 Rd. /''L3._ s� tul
MaMn Address Mailing Address
Cftv/5tate/Zlp Citwstat ip