56684D - Campbell

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The purpose or thus forrri is to provide proper norice io you as an adjacent rpanan property own- er to the individual or
=.ndiyiduals listed belcw. T.Ie CA_%,1,?. Ge_,aral Permit application procedures require that applicants provide the Division of
Coastal Vianagelne:it con=irmaiion that a iwirten statement has been obtained sighed by the adjacent riparian property owners
indIcatiing that t hev have no objection to the proposed work or that the adjacent riparian property owners have been notiiled
by cernfied mail of the proposed work. Often these forms are submined to the adjacent riparian property ovimers by a marine
conE-actor or other individuals acting as an authorized agent on behalf of the applicant.
This tot rr, was sent to you by the following individual or company designated by the applicant as an
authored agerlw- �-
il1
111
C 9e s i laiilrs?
Da -Le
N ame of individual A%palying For Permit: 'O/u/'���C f��/ �
Address of Pr ooe n -
LOT or Jtreer =, Stree: or Road)
Oi ✓Lo s,/
ciirtii and County,) /
iereb} certify that i osvn property adjacent to the above -referenced propem. The individual applying for this perrni
" .described to isle as s1sown on the attached drawing the nm devetooent they are proposing. A description Or drawine
%;.,. dimensions, should be provided with this letter.
I have no objections to this proposal.
u have objections to what is ?being proposed, please write the Division of Coastal V€anagenent, iZ'
or cal19I-79b-i2iS within 10 days of receipt of this notice
al Drive Extension. `v��ilmington,'-1C 28�
a §pbuse is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
ItA&naa€td that a pier-, dock, mooring piLggs, breakwater, boat house or brut lift must be set back
33 .tam distance of x5` frorn my area of riparian access - unless waived by me, -(If you wish to waive th,
tbScJj, you must initial the appropriate blank below.)
l do wish to waive the i ' setback requiremem.
T do not wish to waive -he ' setback requirement.

DIvISIO, ;; COALTAT MANAGEMENT"
ADJACENT RIPARIAN PROPERTY OW-iERIvOTIFICATIOtN!WAFVERFORIM
he purpose of this forrn is to provide prosier no ice to you as an adjacent riparian property owner to the iriidividual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division
Coastal Management cortatmation that a .vrirten statement has been obtained sipped by the adjacent riparian property o
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been no e�<
by ceri led mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners .bya.tr
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This fore was sent tv you by the following individual or company designated by the applicant as an
authorized agent:
ti artie of individual Appivive for Peznit OMY? CdA&3 4'
Address of Property: (o y 1 At W
(Lot or Stree: =, Street or Road)
Ciry and County
,h_-rebv certify that I own property adjaee:, to :he above -referenced properry. The individuzl aupl-ving for this Perth
.described to me as shoLvn on the attached drawin the development they are proposing. A description or drawim
W�
th ditrcerisions. should be provided with this fe ter.
I have no oi7iections to this proposal.
,you have objections to what is being proposed, please write the Division. of Coastal Ma=lagetnent, 12
inal Drive Extension, Wilmington, t C 28405 or call 9I0-746-7215 witf' hin 10 days oreceipt of this notic,
N,o,respouse is considered the same as no objection if you have been notified by Certified 'Mail.
vv --VER SECTION
t u_ndwrstand that a pier. dock, mooring pilings, breal�water, boat house or beat lift muss be set back
t aimurr, distance o 15` from any area of riparian access - unless waived by me, (If you wish to waive tb
ter ,-you. must initial the appropriate biank below.)
I do wish to waive the i 5' setback requirement.
do not vvish to waive I5` setback requitement.
Lam_ �

X Division of Coastal N19t, Habitat Impact Computer Sheet
pplicant: V&� 1 a btu, Permit #
ate: 14 l•
-41 Of I
qP 5(0(0 4�1
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat 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)
D(k)
Dredge ❑ Fill ❑ Both ❑ Other
H 00
1 M
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 ❑

PILINGS AND MORE
JOHN CASSIDY
PH: [phone]
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460
P
Yto the
order o
7'"—),,.-1 1-tvm era,
First Citizens
Bank ��P5�y-D
firstcitizens.com
For C
5841
66-30/531
lG9' 457
Dnte
$�,
_ Dollars
NP