56564D - Mitchell

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to h /'}rlp S /' ►, In P & 's
/' Na a of Property Owner)
,roperty located at a3 S W h k e Let- 6 �..e e, !/
f , �► I // Lot, Block, Ro d, et
in W Yl�eLe JS �✓ ee , in S_ �1 e P2 /,/^so N.C.
(Waterbody) (Town and or Cou ty)
kpplicant's phone #: �'1 r(� �- �16 7 M�J1142&1:c
p0 " © 4 Q
erg JtV<` gklf6o
-le/She has described to me as shown below the development he/she is proposing at th location,
tnd I have no objections to the proposal.
----------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
P ►� e w S"� �- w l l �, S(f p w l4-vf' U'
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If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writ
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, N4
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
(Property Owner Information) (Riparian Property Owner Information)
Signature
Print or Type Name
Signature
Print or Type Name
Mailing Address
Mailing Address

Division of Coastal N19t, Habitat Impact Computer Sleet
flicant:'M(4 ll (AUr(JA t; k- b*ermit #:
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scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd 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
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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 ❑

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8003. August 2006 See Reverse for 1—t

■ 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.
1. Article Addressed to:
i
DELIVERYCOMPLETE THIS SECTION ON
A Signature
/
A3�4 gent
:�Addressee
B. R ived bby (( Printed Name
C�ate�o5f yDelivery
7 �� "✓ ' �
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D. Is delivery address different from item 1?
❑ Yes
If YES, enter delivery address below:
❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7008 1300 0000 2289 2992
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ 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.
1. Article Addressed to:
S
a�4�D
A.
X
Agent
13 eived by ( Printed Name) C. Date of Delivery hI
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D. GIs delivery ad8ress'different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
I R Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7008 1300 0000 2289 2961
(Fransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ 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.
SECTIONCOMPLETE THIS ON DELIVERY
A Sig
X / Z� ��� ❑ Agent
❑ Addressee
B, RecIved by (PHy ed Olame) C. Date of Delivery
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D. Is delivery address different from item 1? ❑ Yes
If YES_ enter delivery address below: ❑ No
1. Article Addressed to: