57315D - Canady

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: / (��i'( �/%�9/ (� � �a
Address of Property.a is (-u� %von. �Dp �� �i�-C-Awe-,--
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 9/0 -l0/ 2-zf�5�z Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, 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. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. 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 lift must be set back a
minimum distance of 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' setback requirement.
t I do not wish to waive the 15' setback requirement.
(Property Owner or a ion)
Signature
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rint or Type Name I
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Mailing Address
(Rir Property O er Information)
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Si�j'fature
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Print or Type Mame
�37 E, V '4er 5 fir-. 12d.
Mailing Address

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Weather Shield'
Premium Windows & Doors
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IC Division of Coastal Mgt. Habitat Impact Computer Sheet
pplicant C a� Permit #: Sl
ate: 5131) W
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
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.
ebitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
romp imn HO
imnnrt mmnunt)
temn impacts)
amount)
1 I Dredge ❑ Fill ❑ Both ❑ Other
)mplete items 1, 2, and 3. Also complete
im 4 If Restricted Delivery is desired.
int your name and address on the reverse
i that we can return the card to you.
tach this card to the back of the mailpiece,
on the fron3 if space permits.
ticle Addressed to:
cJ,mc--,A $oromhs
� 3 S+vo� ' C o
A. Signature n
X I t ( ❑ Agent
Addressee
B. Received by ( Printed Name) C. Date of Delivery
n; C(&e1 4Vru4, 3/ 19/ l 1
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. S ce ijrpe
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (.Extra Fee) ❑ Yes
Icle
Nu
mber from
service, 7010 1870 0002 2978 8752
vrsfer
xm 3811, February 2004
Dredge ❑ Fill
Dredge ❑ Fill
Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
❑ item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
❑ ■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Dredge ❑ Fill ❑
Dredge ❑ Fill ❑
1. Article Addressed to:
J& Sow
_ 1
102595-02-M-1540
A. Sig(
X
B. Rec
( Printed Name) I C. Date
D. Is delivery address different from item 1? ❑
If YES, enter delivery address below: ❑

I
ED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
Bank of America
ACH R/T 053000196
4426
66-19/530 NC
702
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AUTHORIZED SIGNATURE
11800442611' 1:053000L961: 00068474373811'