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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: William N I fiCW I -rQdd
Address of Property: ��( 5o SaJ Wo v g,5 L I 5q) vhol
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(Lot or Street #, Street or Road, City & nCounty) Z
Applicant's phone #: ( O - 4 43 - Q 2 q5 Mailing Address: 1 140 I Us fpw h P-d N
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I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pern
has described to me as shown on the attached drawing the development they are proposing. A description of drawir
with dimensions, must be provided with this letter.
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 (DCM
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive E:
Wilmington, NC 28405-3845. DCM representatives can also be contacted at (910) 796-72t5. No response is
considered the.same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or Iift must be set back a minimum distance
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.)
I do wish to waive the 15' set back requirement.
✓- I do not wish to waive the 15' set back requirement.
(Property Owner Information)
'010� / O
Signature
Print or Type Name
1140 ( U65iW n Rd 00
Mailing Address
(Riparian Property Owner Information)
Signature
.OD l?rn + 1es t uc,
Print or Type Rame
I Li 120 aa41041 flack w 4 L4 a
Mailing Address
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W,b aJ4-1 V tA-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORPVG PILINGSBOATLIFTiBOATHOUSE) / '
I hereby certify that I own property adjacent top ), l �, AA I'1(. I (� IS
(Name of Property Owner)
property located at r13P �i�l't�' One/—)L)
(Lot, Block, Road, etc.)
on J� �Pil�i4Air.,.0,eje, R , in u rJ '6 N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 910*443 g2-g5 Mailing Address:
146 VZ0Ssial0n P-d Nu)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
l I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
(1-4 0 QtisstoLon Qd �3 0
Mailing Address
(Riparian Property Owner Information)
tf-
Signature
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v EDGE OF MARSH GRASS
1
lip
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320'
I
EDGE OF MARSH GRASS
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1 EDGE OF MARSH GRASS
EDGE OF MARSH ORA55 I EDGE OF MARS
NAME OF
BODY OF WATER
SASPAN CREEK
AT LOW TIDE I
70' I
WOODEN DOCK I
16' 6' 142'
LOW WATER 8'
EDGE OF MARSH GRASS
90' 1 0' I
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8
EDGE OF MARSH GRA
LOT WIDTH
PROPERTY OF IPROPERTY OF\Lu
J WILLIAM MITCHELL TODD o
WILLIAM A TODD 1750 SALT WORKS LN m PROPERTY OF
W\ p PROPOSED PIER &DOCK NC PROPERTIES 1LLC � �

dicant: W � L � a y,� i �—� l ( p � � Permit
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;vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
tat Name
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
L
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■ Complete Items 1, 2, and 3. Also complete
Rem 4 If Restricted Delivery Is desired.
Dredge [ ■ Print your namd and address on the reverse
so that we can return the card to you..
■ Attach this card to the back of the mailpiece,
Dredge [ or on the front If space permits.
1. Article Addressed to:
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A. Signature
X ❑ Agent
❑ Addressee
B. Received by (printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: WNo
3- Sery Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
Dredge [ i 4. Restricted Delivery? (Extra Fee)
2. Article Number
(transfer from service 7010 3090 0001 1220 7397
Dredge [
PS Form 3811, February 2004 Domestic Return Receipt
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other 171
❑ Yes
102595-02-M-1540
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