57511D - Mitchell

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to C/ WRIJG f: M/ me6r4c 's
(Name of Property Owner)
property located at 7406-9 .349I/6AOI 5 T.
on
(Waterbody)
Agent's Name #:
Agent's phone #:
(Address, Lot, Block, Road, etc.)
in JuAP GPI 7*1 , N.C.
(City/Town and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and 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)
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.nccoastaimangement.neticontact—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
(Property Owner Information)
Signature
cti�Rll� F/YI��►�// _
Print or Type Name
(Riparian Property Owner Information)
Signature
Print or Type Name
W SP, Seywlk 54 . _
Mailing Address
70.5-dl 5,6 ✓ CMJ7N ;6 T.
Mailing Address

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to YIC©". 's t (Name of Property Owner)
property located at % OE a, % Te-ed-
(Address, Lot, Block, Road, etc.)
on in , N.C.
(Waterbody) (City/Town add/or County)
Agent's Name #:
Agent's phone #:
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and 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)
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
(Property Owner Information)
i4- 9
Signature '
f A�itE yc-, /►itAC,1 C%f' —
Print or Type Name
-
Mailing Address
(Riparian Property Owner Information)
41)nttukre
7 ?J
'Prnt or Type Name
M iling Address

licant: /icy` G S�
Permit #: �7 /
gibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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)
w
Dredge ❑ Fif Both ❑ Other ❑
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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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Charlie 9 aifd,,Wry Z. ✓ itchell 66-30/531
7o52-7MI St 457 6723
SWI City, JVC 28445
PAY TO THE
ORDER OF
D C-/ (�P.
DATE
11 nok IClO / ll��DOI I ARS s
First
Citizens
ffistcitize s.com t-�-- L'0019
FOR
1:0 5 3 100 3001:000 7 6 6 243 13 2 5u
' 0 723