51371D - Blackburn

CAMA/ ❑DREDGE & FILL N? 51
IENERAL PERMIT Previous permit#
dew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina,Department of Environment and Natural Resources t,
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 1"' , 1 101)-7 1-► - )�3
,,Mules attached.
Name 5O }WW4 t trLAQ N Project Location: County
3440 LI Z. iQ 2 . Street Address/State Road/Lot#(s)
))LNA I .. State ZIP 4LY' 7.�( ` K 11 j E; - )I k(' 4-% t( •
90 am-iotatoto Fax#( ) Subdivision
d Agent City �''tU \ ( ZIP �Z 4-2
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EEW .PTA. HIES 'PTS `, Phone# ( ) River Basin P(1
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body NE CA1)iI `-04g Ii\ 1a n
❑ PWS: ❑FC: �/
es /19 PNA yes / o Crit.Hab. yes / no Closest Maj.Wtr. Body C * 1t&
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ig permit may be required by: f�Gl�• n See note on back regarding River Basin n
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J BLACKBURN FLOORING CONTRACTOR 2 0 0 0 .
3400 F ED BERRY DR.
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WILMINGTON,NC 28409 0
66-46-531
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4-212'/
DATE ° 11
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: j ' j42.6( ,r
Address of Property: e1- eeH c.c) r';PNc--\
(Lot or Street#, Street or Road)
Pofc1•x,.) ' e r Co o
- (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 Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must b
bck a minimum distance of 15' from my area of riparian access-unless waived by me. (II
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.
ettAlial a 7*44 ? e2 0 -OS?' /C.#3.1.4 W/IV
Sign Name Date
/ntas44 if A 6 J tehigic
Print Name

LJl V 131kJIN Vr I.,VHJ 1H1, IVUUN1-.L7r1V1.CIN 1
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: J11 ,�,�
Address of Property: '7 .<,�r ;ecH eomo (r' 0:.%C•-`
(Lot or Street#, Street or Road)
C? icy c? c)•-
-- -_ - (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 Cox
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must b
bck a minimum distance of 15' from my area of riparian access -unless waived by me. (If
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.
ql.ce4x 0,/ S'--76-147
iSm Nam Date
4 x Clo
Print Nam ' • •