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Spt%f S Design
�Ip S Floating docks
_ } Pilings
A Howe pilings
Boat lifts
D�visioN O� Co�;a~r�,i �rtAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTMCATIOKIWAIVER
FORM ,
Name of individual applying for the permit_, 1A.,aaad Ada"-
t .�,ri�.r' f i✓t 0
Address of property. a9 lIL'%?�1 �ll��''�
Q,ot or strma, street of road)
(City & 6nnty) -, .4le".1 Avv 00 re Camay
I hereby certify the I own property adjacent to the above referenced property. The
Individual applying for this permit has described to me (as shown on the attached
drawing) the development they are proposing. A description or drawing, with
dimensions, should be provided whit this Ietter_
. I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, IM Cardinal Drive Extension, 'Wilmington, NC 28405 or call (910)
796-7215 witbin (10) days of receipt of the notice. No response is considered the
same as no objection if you have been notified by Certified Mail_
Waivw $edion
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags must be set back a minimum distance of 15' From my area of riparian
access unless waived by me_ (If you wish to waive the setback, you mast initial the
appropriate blank below.)
y/ ECEiVED
I do wish to waive the 15' setback requirement ��
, AY 19. 2011
I do not wish to waive the 15" setback requirements
411\1G: ON, NC
dt
At Or
era
Signature Date
initials where it says l do not wish to waive my 15' set baci
print your name.
telephone number with area code first.
CER•I'IFIVD !UUL— jRF,:EURN RE&;h1j'T REQMMED
nl VISION OV COAKFAL %IANAGIEWN'T
0.11ct±ar T RIPARIAN 1'ROPIX1'F OWN R N(MVECATIOKi'WAIWIt
FORM Ale) \
.,f inllitiiduid appl.vivA for the prrutit: 4A je,42 111&4'fw e Ca! Sf �'vC/`�v`• l �'7C
:,ti nP pn►pert7: L��a�.yl,;�.f� C
%7
Iry urttlfv the 1 ow7s to the above r4marod proper:v. '17tr
dual tttsplyifg for toil. Ix rmil bu dtscdfkd f„ mr w" shown on the allaclwd
nut Wr de,.cbpntent they stre proprrsfnx. A lie criptinn or drawing. wide
t stw►uki Ile Iwo-4drd whk tbk letter.
1 11111c rw► IIItj!•ctions tt► th1% p1r►ptlsnl
tnli-r ohket oas fn "but is IN•tnp proposed, pleas writ:•. Nav Division r,f t'n,.stul
gemenl, 127 Owdlnal ttrlve kstenvk►n, Wilrrtiubtnn, NC 2FA05 ar tidl 49101
.li Within s 101 &l vs d'recdpt d the rutllm No respon5t is mmidcrod the
:.� no objection if you bare hrru notified toy C e"Itled Mail.
WgNrr Striiun
rrdand that a pier. deck. tnooring pilings. hreAwater, tumfliarse, lift ur
togs want be wit ht+ek a minietwtl dionnev of 1S' Ftc►ro Xfy arre of rtpar;an
uultss rai.rat lsy me. flf yvu Wish to Wake for with", You Must btiOW the
priate Mnrtk In4iow.I
w w.ri.c (ix 13' salmi:+ rgvirm tit
L 411 :sjih a; ►rdsisa tltc 15' st'batk mquitmicntr.
Division of Coastal Mgt. Habitat Impact Computer Sheet
)licant: )Av/?/ P Permit #: -S-73-5`3
:e: . '5- �q / //
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
iitat 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)
,, /
V ✓
Dredge ❑ Fill ❑ Both ❑ Other
�7
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 ❑
" DUNCAN MARINE CONSTRUCTION, INC.
2728 N 23rd St.
Wilmington, NC 28401-2755
MARME (910) 256-6620 °a01°�0
�ux-no+.ow DATE
TO THE�v
ORDER OF � J ir/�1 /ll ldi�v wti �/�l�c✓S 0 DOLLARS
BANK OF AMERICA, NA
n r rr-t c- n� 1
FOR 1 OK /I h1Z &Vlz