54010D - Wallace

1
_CAMA / DREDGE & FILL r'
EN E RAL PERMIT IT Previous permit#
_,New -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
.rized by the State of North Carolina,Department of Environment and Natural Resources V
Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC i O
7Rules attached.
nt Name i JG: N P+.-i-A G ' Project Location: County 1J DL A—
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zed Agent L jam ,> E City SAR- C"v-y ZIP Z42.L
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•f Project/Activity 51 a.;.. L 5 LT ,)L Ai1 (�L LZ Y E Y
(Scale: 111_
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ling permit may be required by: ,.t.4e.P CT 1 y H See note on back regarding River Basin i
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., S
Authorized Agent Consent Agreement
k0 u . cv- 'r` is hereby authorized to act on my bel-
(Printed Name of Agent)
-der to obtain any CAMA permit(s) required for the property listed below. The authorization is limited tc
�ific activities described in the attached sketch.
;ATION OF PROJECT:
1—(-)A 4 0 (e R.-4.e( �f,v
v� C, N C—
JPERTY OWNER MAILING ADDRESS:
r/6 WAl14C E
257- 7DIAA)C.7
J67° f PHONE NO. (WO 01—
THORIZED AGENT MAILING ADDRESS:
Lighthouse Marine ConstrUCt On Inc
Post Office Box 2532
Surf City, NC 28445
[phone]
PHONE NO. 1 Q 2-6 2 �'y

n� SALE:M 4�OMENS CARE PAGE 0310E
05/2_ 2009 10:00 3303322233
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMDOIRINGPIIJNGS/BOAT /ROATNOUSL)
I hereby certify that I overt property adjacent to_ j-e (,i I c
(Name of Property Owner)
property located at L ( '1 0 (_0_ `3 ,
(Lot,Block,Road,etc.)
p , ? SOS.,,,( Sc-it.- ..
(Wa y) (Town and/or Con nty)1
He has described to me,as shown below,the development he is proposing at that location,and,I
have no objections to his proposal. I understand that a pier/mooring pilings I boatlift I boathouse
must be set back a minimum distance of fifteen feet(15)froth my area of riparian access unless
waived by me. (If you wig to waive the setback,you nit initial the appropriate blank
below.)
Ida trot wisb to waive
I Lig wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled In by individual proposing develop
'Da•P'Ns (
•
Signature
1 IL L

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO l IFICATION/WAIVER FORM
\lame of Individual Applying For Permit: \'1 a,At x.---
kddress of Property: 4 -e--9-v\4 /
(Lot or Street#, Street or Road)
X-& N�
(City and County)
[ hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl:
are proposing. A description or drawing, with dimensions, should be provided with this letter.
have no objections to this proposal.
P P
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-7 q •
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse or boat lift must
set bck a minimum distance.of 15? from my area of riparian access-unless waived by me.
you 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.
cg)64_4(..—
Sign Name . _ Date
AWA

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'�.ww.,,.--are. w�Y.:i :-..,...:..........-..:..>>.,......... -
LIGHTHOUSE MARINE CONSTRUCTION
P.O. BOX 2532
t
SURF CITY, NC 28445-0028 / - -'CCU
DATE
7 PAY t TO THE AIL D 2J1/
I ORDER OF ���\\\\ I $
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f 0 /t(7---------75131
1 Bankof America
ACH R/T 053000196 \,4)---r---,40.4
f / 1
g FOR GP $�4U1 «. Ga.)
3
II'0035340 40 5 3000 1964 00065131136711'
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