53979D - Wood

[LAMA,if DREDGE & FILL -'.
GENERAL PERMIT Previous permit#
CSNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC )H• UZ'
❑Rules attached.
nt Name ED,J11% vt1 0-St) Project Location: County cN)s ►,off
s Zy Li i AL.c,.- .5 CAP 55 tl..1,q aS 12 Street Address/State Road/Lot#(s)
`�.n� 041,>,_._‘, State NL ZIPZS'a/ 12 L-- 4>e-Lc- P 714--s T 12J-
/ ( ) Fax#( ) Subdivision
ized Agent City S N&q -,E./1 bL 1 ZIP 2Lf(s
d =i CW QEW JTA ❑ES I] HZ�!
PTS Phone# ( ) River Basin vY
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Adj.Wtr. Body �1C I� , �11y 6AlNaL nat
PWS: ❑FC:
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body 'V F- �1. 6-
►f Project/Activity 7..--.IS-S A L L . ) 1—J1, I n-" g 13 Al L-Z 1(T -S..r fS5 Z r
(Scale: t "=
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ength � --- i i ------- � --
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lax distance offshore
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not sure yes ® ILL 6 e A O t 1 r C _ ,
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cgs: not sure yes � -
wium: n/a yes o i111
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•Attached: no
iing permit may be required by: r )N i t/..) C_.e blikv,�j..I . n See note on back regarding River Basin

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name o€Individual Applying For Permit: fidAeLi
Address of Property: Ad,
(Lot or Street#, Street or Road)
' r r
(City and County
I 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.
I have no objections to this proposal.
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 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objectiot
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house 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.
C ge
r�® • Date
Cc y /G 4/ Ad Oct

DIVISION QF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNERNOTIFICA"IION/WAIVER FORM
Dame o€Individual Applying For Permit: e,Y/x.42.
Address of Property: I a aZ Azi& f4�4 JTt
(Lot or Street#, Street or Road)
(City and County)
I 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 ti
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
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 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objectioi
you have been notified by Certified Mail.
WAIVER SEC'TiON
I understand that a pier,dock, mooring pilings, breakwater, boat house 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.
//'
Sign Name
AVA
Print Name � �

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EDNA WOOD NCDL 240983 3767
i PH 919-894-4781 3
2441 ALLENS CROSSROADS RD. c� 3
} FOUR OAKS,NC 27524 •• (4 2I O ! Date +
66-30/531 +
191 !
s Pay to the 1 ,
t Order of N�bTG I $ Zoe .' 1
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1:053 L003001:00 L9 L704657010 03767
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Harland Clarke
GUARDIAN SAFETY®BLUE