57413D - Honeycutt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Ste_ hp",.g is
(Name of Prope Owner)
property located at q 6 �o CI *"- -54-
(Lot, Block, Road, etc.)
on S CAIJR �, , in 9A4 N.C.
(Waterbodndy) (Town and/or ounty)
Applicant's phone #: "L h Mailing Address: 02- tA-e'Picat
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set 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.)
I do not wish to waive
X— I do wish to waive that setback requirement.
--- -------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Per 't
Mailing Address
(Riparian Property Owner Information)
,o /� Signature
of l�l LTV �

ADJACENT RIPARIAN PROPERTY OWNER STATEMMNT
(FORA PIE"fOOMG PLEL•vGSMOATLl'P'TIBOATHOUSE)
I hereby certify that I own property adjacent to
(r"ame of Property �,ner)
property located at 4`b � q-h- '54
(Lot, Block, Road etc.)
P \ , in _S�1 , N.C.
on
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (I5) from my area of riparian access carless waived by me.
(If you wish to waive the setback, you mast 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 DEVFLOPMENT:
(To be filled In by individual proposing development)
it you have objections to what Is being proposed, you must notify the Division of Coastal Management MCM) in writing
within 10 days of receipt of this BOOM Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
•DCM representatives can also be contacted at [phone]i
No raoonse is considered the same Mao obiWkn if vqu have been notified t�Certified Mail
(information for Property Owner/Applicant
Applying for permit)
Mailing Address
City/State/Zlp
Telephone Number
` 71I1Ir—
Ci....n ate
(Riparian Property Owner Information)
/ ignaturo
Print or Typo Name
tr- o1 go
Telephone Number
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Dato

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9

q0A- 914, S-1
LTD
IWA
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owner Applying for Permit:
lb 1224 0611
Mailing Address:
I certify that I have authorized (agent) S ld Lk n 6 `` ��� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) yGTD
This certification is valid thru (date)

C Division of Coastal Nigt, Habitat Impact Computer Sheet
ipli.ant:3 4m-qu4-
r/,, �Ac)ri -'Cl'a - Permit #: 5 3
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat 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 ❑ FillX Both ❑ Other ❑
1� O
H O
Dredge ❑ Fill ABoth ❑ Other ❑
V
O
Dredge ❑ Fill ❑ Both ❑ Other
V
V
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 ❑