56643D - Borrelli

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date d A o d 6l o
- r
Name of Property Owner Applying for Permit:
0err1 /d ,9OL '
Mailing Address:
N
I certify that I have authorized (agent) G<��ious�/4r/ld� �JYZff�tU�l/(JY' to act on my
behalf, for the purpose of applying for and obtaining all CANLA Permits necessary to
install or construct (activity) JC,= LOA
at (my property located at) l S — ilo wc-- S-{ K Id,3C S. Tf. cov
This certification is valid thru (date) 3 // S/� 0 /
Property Owner Signature Date

L/ #

�Z r :tiY
Name Of _ndividual Apply ing For Permit:
l� C.ilil �
Address Of Property:15
,4 � � �Q.:.y
el- IC / )
(Lot or Street
>l)C
eatr
c
o� Road, i =Y: Count"
I hereby certify that I own property adjacent
referenced property. The individual appy for r to the abflve-
described to me as shown on the attache
they are .proposing. A descrido_ this pertrs` has
drawing the development
ption or drawing, with dimensions
should be provided with this letter. ,
I have no objections to this proposal.
c -ha
'
o �
i uads rand tit .a pier,
souse
dock, -maor�mg a i1gs , sb. r-a:rWa,boat
ar 3aat 1i�t must be
set bact
c _m1i� distance
mt• a= ea Of iparimn
..
access
'. iTTagS5
of .2 5 1 dram
Wc4'VeC'.'.
Vial've the setback.,
you m
:ritia?
DY .II1e. (=- .� L• wish O
the zOpropiiate
.blaml- beiaq�.}
S do
wish t0 waive 5 • sez ba^, = eC-rU=Temenz
V ? t�2n.2t
wish
to waive
the 15'setback -ra ir'a�
� nt_

Name 0f _:ldi-vidual Applying For Pe=it:
_U t
Andress 0= Property: Lort5 15 �p S pp
(Lot or street e...4 Street Or � _. �
RoadC'
tY. Coun -v
I hereby certify that I own property adjacent
referenced property. The individual apn1 �to the move_
y
described to me as shown on the attachedngdray,T_n
fo this ae�i1t has
they a=e=roposi_ag. g the development
A description or drawing, with dimensions,
should be provided with this letter.
4WIll have no objections to --his proposal.
a '' rjfmr-c you "n;4Lra
o a is
T C
uaaersyR7i[7
pier, sock _�-; mao_� airings, br +
halzse cr boat 1i¢t =ist be set ba :r a eta er, boat
4 r .muu: distance a� ._5 ► _- M' ar eZ Of i'za :ian ac^eSs ; a - CxM
- uZless Waved, 1>V .nle.
v�aive .the Setback, you you wish to
Y m to t itial the aagropriete b1ank belov.% )
Z do w' st! :.O wal ve she _.7 ` se.�a^.1s ,--ecru
1TeMe=_- .
dO—nnt wish to waive the ZEj1setaack
t'qui- r`m-ent
Sign Name

11

C Division of Coastal &19t. Habitat Impact Computer Sleet
)plicant: �6A'o 90VIMLL, Permit #: q 5ic1(cq
ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
DISTURB TYPE
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)
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
5
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 0

8
0
0
Gerald Borrelli
NCDL 6191514
16 West Ridge
Surf City, NC 28445
1326
o „ 66-7549/2531
Date —
Pay to the order of / " G Z) $
r / ;?Z. c
COASTAL FEDERAL CREDIT UNION
P.O. BOX 58429
RALEIGH, NC 27658Np
For — ------
1:253 175494r:000 1073 2 20065011' 13 26
C DESIGNER CHECKS ® • SEASIDE