52519D - DeGrange

' CAMA / '—] DREDGE & FILL
`ENERAL PERMIT
Previous permit # a
New ' —'Modification !-]Complete Reissue --:'Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7H
ules attached.
Named �L�rnC i �f 1� �'�
Project Location: County (� �:Lj�j j j(_V—
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Street Address/ State Road/ Lot #(s)
r Z ft�71 stateZI P2 I
( � 4 70 Fax # ( )
Subdivision Fr-,2 CST tt`l L L�
:d Agent
CityL-E-li io ZIP 2,8L45
J CW IfVN PTAfS ❑ PTS
Phone # ( ) _ River Basin . (�
OEA =1 HHF - IH C UBA 7 N/A
Adj. Wtr. Body rr
-' PWS: ❑FC:
ees / no PNA yes '( Crit.Hab. yes / no
Closest Maj. Wtr. Body
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(Scale: ri /i ; 4
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Flame of Individual Applying For Permit: G�CA
Address of Property: L o �01 L2n ` �l c ► V�
(Lot or Street #, Street or Road)
aV"\oA N C a ck/}`j I h'Cu ►n
(City and County)
[ hereby certify that I own property adjacent to the above -referenced property. The individw
applying for this permit has described to me as shown on the attached drawing the development the
are proposing. A*scriptign or drawing, with dimensions, should be provided with this letter.
If you have
have no objections to this proposal.
what is being proposed, please write the Division of Coasts
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be se
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yoi
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
�i�
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ame of Individual Applying For Permit:
ddress of Property: 1 1 9 L ova 2!;X
(Lot or Street #, Street or Road)
Le 1 a,� J N C a
(City and County)
lereby certify that I own property adjacent to the above -referenced property. The individual
plying for this permit has described to me as shown on the attached drawing the development they
e proposing. A description or drawing, with dimensions, should be provided with this letter.
_e!��,,3t 0 I have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coastal
anagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
ithin 10 days of receipt of this notice. No response is considered the same as no objection if
iu have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set
k a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
'�sh to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
S I do not wish to waive the 15' setback requirement.
p Name Date
x1'f11x",� A
int Name

LESTER DEGRANGE, JR.
�z9„ssas 3305
CHARLOTTE DEGRANGE DATE3� aC� � 0�
117 LONG LEAF DRIVE
LELAND, NC 28451
. - -, r— . , ;'\ I $ a00.00
PAY TO �Y1O
THE ORDER O ^ n LLARS
CO
State Ern to e� es redit Union*-.--
"°"" Leland Northo
179
MEMO
AL
1:253L77049,:086293L5946ll' 3305