56665D - Wall

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to�c. 0. m won s
(Name of Property Owner)
property located at 1 So y
(Lot, Block, Road, etc.)
on
Z � in Tan , N.C.
(Waterbody) (Town an or County)
.
Applicant's phone #:AXC -�q5-�3�0 Mailing Address: �SO a �titre�[T" '
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------- -- -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
oC�% C\ OS
CL o c�
o a.
2'
� go
- - -------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature

t k-o ,,d - d C/i ✓c y
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
e a "`-' l�
I hereby certify that I own property adjacent to � s
(Name of Property Owner)
property located at ►SD
(Lot, Block, Road, etc.)
on ��WW ,in ��\�`c��`C� NC ,N.C.
(Waterbody) (Town an r County)
' hone #�0 -Sq 5 W4G Mailing Address:
Applicants p e 2�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-----------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
\50��r�(Za
Mailing Address
(Riparian Property Owner Information)
Signature

Diwisaon of Coastal N19t, Habitat Impact Computer Sheet
licant: � �(/1 a C l Permit
cribe 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
Dredge ❑ Fill e Both ❑ Other ❑
Dredge ElFill B Both ElOther ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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
impactamount)
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
g0
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 ❑

PATRICIA M WALL
1504 BURNETT ROAD
WILMINGTON, NC 28409
[phone]
PAY TO
O
ORDERF
ORD�F
(11 First Federal
2752
67-7194/2532
DATE
a
DOLLARS
1:253 271945j:57050063631Is
02752