57500D - Wooten

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Wilmington Distract It
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539" N
Map Date: I
Imagery D,
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Map # saw
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201
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Lat 33' 53' 37.551 N
Long 78' 27' 6.438" W
X 2166393
Y 52786
24
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Lat 33° 53' 37.071" N
Long 78° 27' 8.779" W
X 2166196
Y 52736

US MAIL
CERTIFIED MAIL -- RETURIN RECEIP"I' REOUEST.ED
DIVISION OIL COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property
Address of Property: ____ •< _i5z _7"
or Xreet 4, Street or Road, City & County)
Applicant's phone itU��--- Mailing Address:
1 hereby certify that I own property adjacent to the above referenced property. The individual applying for this permi
has described to me as shown on the attached drawing the development they are proposing. A cription of drawine
with dimensions, must be provided with tftis letter.
I have no objections to this proposal. I have objections to this proposal
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the sante as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift trvust be set. back a minimum distance of
l 5' 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 wish to waive the IS' set back requirement.
_. I do not wish to waive the 15' set back requirement.
(Property Owner Information) s (Riparian Property Owner Information)
Signature Sig attire-
toxoi►i ti T. r u ,stLg—
Print or Me Name Pri .t or Type Name
Maifi,zg Address
City / State / Zip
-A/
Mailing Address /.6 , �j�%

NAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to -,y-
(Name 060ropirty Owner)
property located at
(Lot, Block, Road, etc.)
on � ------ — - in - , N.C.
(Waterbody) (Town and/or oC unry)
Applicant's phone #:J'/��S " -46Z,6-J'' :Mailing Address.
He has described to me, as shown below, the development he is proposing at that location, and, l
have no objections to his proposal. I understand that a pier/mooring pilings / boatlifr / boathouse
must be set back a minimum distance of fifteen feet (IS) 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/OH DRAWING OF PROPOSED DEVELOPMENT -
(To be filled in by individual proposing development)
----------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Inforrnatian)
for Permit)
Malting Address
CitylState/Lip L�"�C 9
Signature
Print or Type Name

a
ljoIPC 1
0 I

Division of Coastal Mgt. Habitat impact Computer Sheet
dicant: *V)njVt VJ Wn4--C4�
e: . I (/,/
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.
DISTURB TYPE
itat Name 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
Dredge ❑ Fill ❑ Both ❑ Other ❑
O
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 ❑

SUZANNE P WOOTEN
WOODROW B WOOTEN
WW ACCOUNT
42 CRAVEN ST.
OCEAN ISLE BEACH, NC 28469-7634
66-679/531
DATE
5017
PAY TO THE ✓I /,� I'� J
ORDER OF , / i �j(-� '0� ooeQ �c G�f/lt?.��
DOLLARS ee`�
PROSPERITY
BANKING
MEMU7
l:OS3 i067991: 070004365611' SO i7