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21
ADJACENT RIPARIAN PROPERTY O`N-iER STATEMENT
(FOR A PIER/M00RI_VG PILI_VGS/BOATLIFTiBOATHOUSE)
that I own property adjacent to 1� �
I hereby certify p p Y J
property located at �.
(N e of Prope ty Own )
(Lot, Block, Road, etc.)
on yVt� (,dL -✓� , in ; Block, N.i
(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 st
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
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
bOcvK 1=(L0+1, l-,qSr coru-wzL or' LoF 225 PitoP�S�� aJcx�K
Y, .y
LOe A-ti-A1 O�: Nf PewPc k1C0 W i.
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W
MkAJ(&4412►if ��+//!Gi" A� (vi1'V �O.� r-XISr
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(aT ZtS 10
T 1VA
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
-„
" J
� .
Mailing Address
mot-
(Riparian Property Own ;7S
tion)
ib a
D,;nt — Timp N

olk/d vGl LvT LZ y ,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to CURISi1IDI NLiZA54.r-4 10,10 's
(Name of Property Owner)
property located at
�223�Lo�� Soy QAVf 6w" 2,D Psr�N� ivL Za"/�i3
(Lot, Block, Road, etc.)
on M (LL in (4 r'g'C48 /UL , N.C.
(Waterbody) (Town and/or County)
2 J� 2-(o'95-7'1 Mailing S % D
Applicant's phone #: Zb g Address: ' C 28yy3
&S
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 (1T) 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
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
LOC� fLcxr C�(o � � Qrl.v�W'i,✓, Lid U� /S -^�' r
cl -Q at f xtS r>,V0, 6oCk . 77>f7 J
li S(�tb2its� D�.tr�(•c.c{ N wc.i� �K44[� w " �- �,
ASV (----LF��sc►Nu
LOT' 1I-\-----------L--T-z1-----L-
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-------------------------------- ---------------- ------
(Information for Property Owner Applying (Riparian Ppbperty Owne Information) .
for Permit)
Soy Pt4v�lj 4,100,D 2D
akje
Mailing Address Sign

Permit #:
;vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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 ❑ Fill ❑ Both ❑ Other
1 �5
� K
VIA
Dredge ElFill ❑ Both ElOther
Dredge ❑ Fill ❑ Both ❑ Other ❑
(0
& ( D �
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 ❑

CHRISTIAN D RIZZO / 30-742813140
ELIZABETH DICKSON RIZZO
504 RAVENSWOOD RD )an
HAMPSTEAD NC 28443-8320
uSAA FEDERAL SAVINGS BANK
10750 M.DERMOTT FWY
SAN ANTONIO, TEXAS 70288-0544
[phone] i $00"892-37�.-
1:3 14074 2691:
1150 3 54 10 Jolla