53145D - Collinson

ICAMA / FJ DREDGE & FILL + .
WWRAL PERMIT, Previous permit #
�'I l�ew ❑ Modification --'Complete Reissue ❑ Partial Reissue! Date. previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources ^7 J�
.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /17• �� d
u es attached.
t Name Ro j C,D%1, -se -,,
31 C& eip ij klo? o 51-1
�1 dewigG/� state C zip 2 yro2
( ) Fax #( ,)
ed Agent 1 C)`l v &0 u
CW 7.EW E 1LPTA ]ES- PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑ FC:
/ Oki C 't H b /
Project Location: County 31 a ,r S w i de
Street Address/ State Road/ Lot #(s) 5 ,,fM C
Subdivision
City
ZIP
Phone # ( ) n River Basin 444.y e
Adj. Wtr. Body("PN,9 L Qar4- �/ w'^� (nat r
Closest Maj. Wtr. Body !� / ti'' At,,
yes Lnv - yes ri . a yes no �//
Project/ Activity f/(, U { ,� / �O c h �� // 714 17—
(Scale:
A) length i azI.
igth
nber
I/ Riprap length
distance offshore_
I
_
x distance offshore_
_.___
__-
cannel
sic yards
)p001,
L.._....
6�
illdozing
x
a
Length S
not sure yes r �,
not sure yes
um:: n/a yes
1) Yes rL? xtached_� G- es) no
ig permit may be required by:
Saecial Conditions RL 1 pl ,v, d. 41111 _ c -O-P 71 / -7i o f> c
❑ See note on back regarding River Basin ru
LI/// Af A n-�o C

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02/20/2004 22:08 9108428517 RICKY HEWETT_CONSTRU twat
ff.ovJa bjjav4�t
ADJACENT RIPARLkN PROPF.RTV OWNER STATEMENT
(FCW A PXLN#i OOREW P1MNG"0A7ZIFT/B0A7N0USP
I hereby certify that I owns prOPqIy Aacetrt O F f ltlo-so tom► —
's
(Name of Property Owper)
Propefty located at ' 3 S (SRN 5 bo (zo
- — C.ot, Block, )tt04 etc.) ,
on r ,in Hbl3f-1.I N.C.
Wet y) ( (Town and/or County)
Applicant's phone #: 910 oZ i 7 4 aS MA-aing Address: 131 G-it'-E�as
He has described to ure, as shmn below, the devclopment he is proposing at that iocation, and, I
have no objections to bis proposal. I understand that a piex/moodug pilings / boatlift / boathouse
must be set back a rniniirmun diswm offifteen feet (1S) frorn my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initW the appropriate }dank
below.)
I do not wish, to waive
rE-�IL 1 do wish to waive that setback requimrnerxt.
DESCRIMON AND/OR DRAWING OF PROPOSED DF,VTJ,01 'NT:
?7-1- filled in by &dividuAl propes'intg developmoo)
40 Rfego e
ge"Ut s�44VMArr dscr
PVPf b A+lr N +'s k�`a
(Information for .Property Ow--,er A,pplyiog
for Pemit)
j-6 6audb 1 —ej-i-
Mailing Address
'ALIh
City/statc/Zip
+
(Riparian PropeirtYOwneJr Worm;Rtiag)----
Signature
tint �'r�

a
1

R.� Hewett Construction
�ic or Cinclu Hewett
P . 10-842-8 17
1'481 S� 2,,7 Rd�S6``037
)THE rr� �ly
WF
2537
66-112/531
BRANCH 62101
DATE
$
e.ox.
IRANC' BANBAIG COMPANY
M'
53 10 L L 2 11:0005 L983859SEPIO 37 _-