57495D - Summersett

8S/28/2011 11:19 9107549894
THE UPS STORE *5072
MVIER T►.
OF
ADJACENT RIPARIAN
Name of rndividual Applying ror Permit:
Address Of Property:
(Lot or street 0,
Ll
�5 �? 4c-,
Road, City & County)
I hereby cartIfy that I own property adjaoent to the aabam-
ref'erenc ed prnporty. The individual opplying far this pozmi.t he,a
desozibed to MO au ShOwn On the attaChad draWiny the devEa0pmant:
they are proposing. A dsacription or drawing, with dimensions,
should -be provi ad with this letter.
T have no objecLiohs to this proposal.
If you haven+ ob ect *ns to what to bsin
Divisions of Coautal fit, 12
Wilmington North Carolina, 28405 or
days of zeresipt of this notice. No re
as nc obJ*Ctidn xr 'vo�u ?navia tse�n ou have —'°•
n^ri f
WATM SECTIoN
ase Wri. t g the
wV Extonsion
,3909 ''thin I
I understand that a piss , dock , mooring pilings , breakwater , boat
hoUss , lift or sandbag$ Must he got back a minimum dimtsnme of 15 T
from toy area of r'P*rian acoass unl"A waivs+d by ms, ( If you wish
to waive the setback.. you must 'mi.tial theapprcypria►ta blank bwlow. )
l Q_� I do wish tb waive the 15, setbaLL-k ,requi r+aQnsn t .
I do not wish to waive tha 15 r notbatcyk raquirement.
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIGIN WAI` -R OR;�
Name of Individual Applying For Permit: a
Address Of Property: I q ) ) )MU"
,-/lLL�lG��c
(Lot or Street, Street'or Road, City & County)
I hereby certify that I own property adjacent to the above -
referenced property. The individual applying for this permit has
described to me as shown an the attached drawing the development
they are proposing. A description or drawing, with dimensions,
shcu�d be provided with this letter.
I have no objections to this proposal.
If you h4vobjections to what is being propo&md , plga.se write the
Divisions of Coastal Management, 127 Cardinal Drive Extension
Wilmington, North Carolina, 28405, or call 910 395-3900 within 1i
days of receipt of this notice. No response is considered the same
as no abjection if you Piave been notified by Certified Mail
WAIVER SECTION
I understand that a pier , dock , mooring pilings , breakwater , bi
house , Lift or sandbags utust be set back a minimum distance of 151
from my area of riparian access unless waived by me. ( If you wish
to waive the setback, you must initial the appropriate blank beloi
I do wish: to waive the 15, setback requirement.
I do not wish to waive the 15, setback requirement.

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C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: �,/� � n m Permit #: 5"Ct s
te: Y IVY LC
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/o
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
' 2
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 ❑

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