51373D - Ballard

❑ICAMA/ ❑DREDGE & FILL
GENERAL PERMIT Previous permit#
VNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Natural Resources
B Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 7 4. 1 \DO
[ 'Rules attached.
ant Name RPN O A _") Project Location: County (1204302,
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sized Agent City Pri ZIP Z Frq
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d ❑CW ❑EW ❑PTA i ES El PTS PTS Phone# ( ) River Basin (t'•T1�
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
I: Adj.Wtr. Body tc l NA/ at
❑ PWS: ❑FC: � � � � 1
OP no PNA yes ie.' Crit.Hab. yes / no Closest Maj.Wtr. Body 1 W Y�
of Project/Activity FR k V aU L {-t;110 (CCO)
(Scale: I"
dock)length
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ead/Riprap length 01 r ►1Etii1`uiiiiridk ' I r;�OI -
rig distance offshore 1b ■■ ■_ � y■�'■_ --_ jZr�
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ax distance offshore II au_■ — _��1�t�7:1rI
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ding permit may be required by: See note on back regarding River Basin
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete ��.
item 4 if Restricted Delivery is desired. �� C
• Print your name and address on the reverse / A 4 C
so that we can return the card to you. r.• Attach this card to the back of the mailpiece, R.ived by(�rnted Name) C. Datf
or on the front if space permits. !I A ( _•
D. Is delivery address di : -nt from item 1? C
1. Article Addressed to: If YES,enter delivery address below: C
i7 ts/��aeisr s--
"._ ' 110/v CEO V.n? 3. Service Type
,Certified Mail ❑ Express Mail
kV/G.i7•
7 ❑ Registered ❑Return Receipt for N
C' r ❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑
2. Article Number 9C'Iw4ehwe.ican 7008 1140 0002 9557 8692
(Transfer from servh
PS Form 3811, February 2004 Domestic Return Receipt • 1025
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25 08 06:55p Castle Bay 910 270 4683 p.2
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNERNOTII~'1CATION/WAIVER FO,R
Name of Individual Applying For Permit: , .14" s I4* J
Address of Property: -"7 l 1e X G,6 W` A
(Lot or Street#, Street or Road)
• 149 ?1 ,0#/ze: .
;City and Ctiunty)._._ • . .... --. . ..--
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions, should be provided with this setter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION
T understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must be set
bck a minimum distance of 15' 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 15' setback requirement.
•
do not wish to waive the 15' setback requirement
•
C:cn \Tan,. T'S��e .

25 08 06:56p Castle Bay 910 270 4683 p.3
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