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C ItT'IFTED t:AIL — IME T'� R YECETFT UCSI'ED
DIVZSIO�+ Of COASTAL Nl.4-NAGEMUNT
ADJACENT MAR AN PROPERTY t NVNER STkfVVIENT
Name of Property Owner: 1 V Lt.
,[ �&n-
Al� .
Address of Vtoperty: _ ,6— -
(Lot or Street #, Street or toad, City & i;oc,tti}
U' V �� Mailing ,,- . /
Applicant's phone #: Addres
+„ d � -
I hereby certify that. I O'A property adjacent to the above referenced props. Ty. The 'individual applying for this o ern'
has described to me as shown on the avached drawing the development they are proposing. A descrigtiQn�JC �,ayd p
with dimeitsign must belsrovide wi�;Uhis letter_.
I have no objections to this proposal.
I have ar lections to this proposal.
if you have objections to what is being proposed, you must notify the Diviaiorx of Coastai iViatiagement (DCNI
in writing witbin 10 days of receipt of this notice. Correspondence 3hou.ld be mailed to 117 Cardinal Drive E:
Wilmington, NC 28405-3845. DCNX representatives caq also be contacted at [phone]. No response i$
considered the same as no ob'ection if oa have been notified b CertifiedMa'l.
WAIVER SECTION
I understand that a pier, dock, rroomg pilings, breakwater, boathouse, or lift 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, yc)u must initial the
appropriate blank below.)
I do wish to waive the 15' set back requirement.
V I do not wish to waive the 15' set back requireme;It.
(Riparian property Owner Information)
(Property Owner Information)
,.....__.._., .....___ �......� Si mature_...._._,..�,......�..._.-._._..__.__._...._.—.....�.
Signature
Pr irtt or Type Name. ?tint or Type Marne
Mailing Address
r
4&. Jd
City / State / Zip
Mailing Address
Girt ! State / Lib

CERTIFIED _MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY O`VINER STATEMENT
Name of Property Owner: 4ty
Address of PropertyJ y;
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tLVL VI aLtf= 0, aUCCL V1 1RV4u, X.11; a l.VUULy
re
Applicant's phone #:—C FFJ�--1Grl �— LL—�L Mailing Address:
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 draw
with dimensions, must be provided with this letter.
___ j/ _ 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 he mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at '910) 796-7215. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, duck, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc
i 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 wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
SignaturVgz& N
Print or Type Name
Mailing Address
to 0
(Riparian Property Owner Information)
S igna ure
Print or Type Name
Mailing Address

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Division of Coastal Mgt. Habitat Impact Computer Sheet
cant: �, c" K►,'�'� ✓� C [ --r- Uj I S Permit #:
;vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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
2
2 �
►�
Dredge ❑ Fill ElBoth El Other
t 70
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 0 Fill ❑ Both ❑ Other ❑

JOSEPH V. MILLIGAN
LARA R. MILLIGAN
NCDL 4319111 4299734
P.O. BOX 131, HWY.130 PH.
ASH, NC 28420, _
66-7143/2531 5554
$
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`06 2000