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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATENIE`T
Name of Property Owner: 1
Address of Property:�C`?��,� ,� Q
�D �T t 2 ! C4r j5ountyJ�" G
Applicant's phone #: al 4 , 994. 299 J Mailing Address:
194667T4124W agFd! d, AIC 2c
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
has described to me as shown on the attached drawing the development they are proposing. A description of drav
with dimensions, must be provided with this letter.
i 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 (DC
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response i
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 lift must be set back a minimum distanc
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.)
[�, F
_ I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Infor ation)
Si /
Print or Type Name
M�
Mailing Address
/ An . - - , - .. _ n._ - . - /r
(Riparia ro ner Information)
Sign e
?Tint or Type Name
JD(2 �, c � A�
Mailing Address
. A

CERTIFIED MAIL — RETLT-N RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: /b 7
"44 & 117T et i *15ounty)2_6 14 G
Applicant's phone #:a14 a _ 0 Qil. 139 J Mailing Address: 0�! g
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pei
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensions, must be provided with this letter.
1 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 (DC1
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no obiection 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 distanct
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 Infor I
ation)
Print or Type Name
Mailing Address
C
pa ian Property Own rmation
Signature
Print or Type Name
1 13 S Cl�vnrtzI��
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER1'1�IOORLti G PILLNGSIBOATLIFTIBO4THOLSE)
I hereby certify that I own property adjacent to � /� /v 4 - «6vk
amegf ropers Owner)
property located at �/
�}--,, (Lot, Block Road, etc.) �[
one/ v 1; in tiU rI-' i�1 C'l ! , N
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I hav
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be
back a minimum distance of fifteen feet (1 5') 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 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)
jN C--x ff -7741& 7z) 111, lt 47L-
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat. Wilmington
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Information for Property Owner/Applicant (Riparian P
Applying for permit)
Mailing Address
Sib al
G Ic -kL"

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CE 7v
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�1, ,o1C�<
ECEIVED
WILMINGTON, NC
IAR 2 4 2011

0.
ADJACENT RIPARI-A.-N PROPERTY OWNER STATEMENT
(FOR A PIEIL1I00RI:VG PILIA•GSIBO-ITLIFTIBO-fTHOUSE)
I hereby certify that I own property adjacent to � �=-/� /f - CCr-k
(NarNO
o er Owner)
property located at ��� �t `�2i
(Lot, Bloc Ro d, etc.) �� ��
in C ��� , N
(Waterbody) (Town and/or County) �—
He has described to me, as shown below, the development he is proposing at that location, and, I hav
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be
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.)
RECEIVED
I do not wish to waive DCM WILMINGTON, NC
I do wish to waive that setback requirement.
--------------------------------------------------------------------------------------144�-2-4-411-----------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Est. Wilmington
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
0 7 J, �, \ r
Mailing Address
(Riparian Property Owner Information
r Inform
ati
mow.
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DECEIVED
II WILMINGTON, NC -
MAR 2 4 2011

C Division of Coastal Mgt. Habitat Impact Computer Sheet
�plicant: avf ,� Caa�- Permit #:
ate:
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 fina
disturbance.
Excludes any
restoration and/(
temp impact
amount)
Q
Dredge ❑ Fill ❑ Both ❑ Otheror__
y L/
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 ❑

CHANNEL DRIVE ASSOCIATES
P.O. BOX 31063
RALEIGH, NC 27622-1063
to the
11-0a 1109
Date/ he bl
66-19/530 NE
97523
Dollars
BankofAmerica���
ACH R/T 053000196
For
1:0 5 3000 19 64: 000 6 9 10 5