56683D - Parks

IJI vlalun-- IYAJL. Niftna%jriVICAN I
AWACENT RIPARIAN -PROPERTY OWNER NOTIECATION/WAIVER FORM
ie.of Individual Applying For Permit
ress of Property:
(Lot or Skeet #, Street of
6,r�y pe!i
(City and County)
eby Certify thg T
I own property 4acmt to the aWve--reftxeaced property- T"ne in( IVIdual
vingfar this permit has descn-bed tome as shown on the attached drawing the development fey
Toposing. A description or dravving with dimensions, should be provided with'thLs "ietter.
I have no objeefioms to tis proposal.
m h,-,.ve abjectiow to what is.heing projwnd, pkase Wylte thti DIV.Won 01 lCoasiaj
agemea4 127 C-ard!" Drive XxtensiolL Wumington.
NC. 28405 or call 910-3�3900
In 119 dzys of r,,=e;.r-t € f th-is Watirv-, No re-sp-a-ase is conAdered the same as no objitefiom
�27,8e beC-E rjrtji by Caged -twaiL
lerstand thRtpierl. dead„ —meormig -
Vi' b reakwater, boat house or boat ITIL:aiust be
6k a minimum dMasce of 151 from myiar= of riparian access - mess waived by me- (if
M-h to waive the setback, yo!.,, m-H-q M-*--ffi-z-1 the appropriate blank ba'1810TV-)
1 do wish to waive the 15'setbAck-mOUT-rement
I do not wish to waive the 11-- setback meet
Name . (::4
Date

��____ 0117 G` �7
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Division of Coastal N19t, Habitat Impact Computer Sheet
)licant: .,, I D v Permit #:
e:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd 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.
)itat 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
temp impacts)
impact amount)
temp impacts
amount)
(Vu
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l �N
l p2
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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 ❑
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Bank of America
ACH R/T 053000196
ALLIED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAY TO THE Eyp—
ORDEfR�OF� v
MEMO (1 f ^tte-5 ��1��
1110044 L4Ila 1:0530001961: 000684743738III
AUTHORIZED SIGNATURE