57454D - Brown

CERTIFIED MAIL, RETURN RECEIPT REgUE5TED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: -.---__- = "I . P� � �r-'.! t� __�-Y-�---
Address of Property: l' `t eA H/1 r )'t-/ O^u'L--.
(Lot or Street #, Street or Road, City & County)
t , - C-'
Applicant phone #: _ iO> 1 7 _ Mailing Address: c%1.U
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. A description or dravrina. vLrith dimensions, must be provided with this letter.
I havc no objections to this proposal. I have objections to this proposal.
if you have objections to %,,hat Is Being proposed, you must notify the Division of Coastal Management �
(D0141) inwriting within 10 days of receipt of this notice. Contact information for DCt1R offices Is�fJ`���
available at lv.w.nccoastalmanL+ar,72nt_neticontact dcm.htm or by caldfngt 1-888-4RCOAST Na' �
reyonse is considered the same as no objection if you have been noted by Certified Mail
0
' WAIVER SECTION �---+------- E � �
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be se't~b a Q�
minimum distance of 15` from my area of riparian access unless waived by me. (if you wio q
waive the setback, you must initial the appropriate blank below.)
v _ I do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Pro rty Owner Information
x
t Signature
n Lee_ 0. QrC L-2 ru Sr
Print or Type Name
A Q bx S-2 z
Mailing Address —
City/Statelbp
(Riparian Property Owner Information)
Sigr!uture
/,%/%n /7% ,C row*,
Print or Type Name
?0 �reenT�ee C1r���
Mailing Address --- l/-� / !�
F _ Uroru d r`/ 7 7` '? O'z
cityistate2ip

+'al -A ' ��4 10t, %, j S

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 2, ID 3
Name of Property Owner Applying for Permit:
. ......... ... - . ......
Mailing Address:
-,Aj 6u) s o W r\z � F 3 'TF
I certifv that I have authorized (agent)&—EnQ toact onniN
behalf, for the purpose of applying for and obtaining all LAMA Permits neccssar% to
install or construct (activity) -r�2a4 A rlp-bu I /d CA ri 10 eA
at (my property located at) LA
X*�, oLtlo "— &JT-, q � Z4
This certification is valid thru (date)
Property Owner Signature I Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: L &' Bel)w r1
Address of Property -
(Lot or Street #, Street or Road, City 8 County) (�
(Mr-. 41/WU41
Applicant phone #: 6110"1 347 Wailing Address: PO 86 a3—
Sao FAALl AJC-
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. A description or dra3uifim= ditie 'sions must be provided with this letter.
f I have no objections to this proposal. 1 have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCMI in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement nebcontact dcm.htm or by calling 1-8884RCOAST. No
response is considered the some as no objection if you have been notified by Certified Mail.
_ WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 se k, you must initial the appropriate blank below.)
��
� I do wish to waive the 15 setback requirement.
I do not wish to waive the 16 setback requirement.
(Prorty Owner Information (Rips an Pr erty n r tnfo ion)
Signature Signs e
Lee C7. 0ra N 7�
k .TA. L9C 2 ►2co 1
Print or Type !Yams Print or Type Name
426 R bjk T2 2. V0 ha ap (0
Mailing Address .. Mai ing Address
l✓A� s�4C . -z 8" 3 �� 5 Ed s ►R rAu , ►�� g? q10
.. CitylStatev p • a CitylStatelzip

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
8 Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
/Article Addressed to:
Tmc�
3 C N ()cc l Or,
A. Sig
.�❑-,X
B. Recived by( of Name) OoC.Dae
Delivery
D. is delivery address different from Item 17 esY
If YES, enter delivery address below: 0 No
3.
Service Type
❑ Certified Mail
❑ Registered
❑ Insured Mail
13 Express Mail
❑ Retum Receipt for Merchandise
❑ C.O.D.
y. Hestncted Delivery? (Extra Fee)
2. Article Number ❑ Yes
(Transfer from service label) 7011 3500 0001 3956 4 511
PS Form 3811, February 2004 - --
--, Domestic Return Receipt

-ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
i in your Habitat code sheet.
DISTURB TYPE
3t Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
'jf Dredge ❑ Fill ❑ Both ❑ Othe
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 ❑ Fill ❑ Both ❑ Other ❑

I CONSTRUCTION, INC.
252 ENNETT LANE
NEADS FERRY, NC 28460
l Iq
BankofAmerica.
ACH R/f 053000196
66-19-530
2165
p/i wr2
c
0
W ` c o m
5
DOLLARS
AUTHORIZED SIGNATURE