50365D - Congleton

V 5
1dAMA/ ❑DREDGE & FILL ..
iENERAL PERMIT Previous permit# S2o33
New El Modification 1Complete Reissue ❑Partial Reissue Date previous permit issued 3,2
-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 , I
7040
,n ❑Rules attached.
Name a 4 C-'°''/! A-t Project Location: County /UGC✓ �1/04.0//t
23P 'j,/10446
p( . Street Address/State Road/Lot#(s)
ill ,,,f o,5 State we ZIP 2 S.`/// 1,4-9"
(Ill) . , }. Fax#( )2C4, ,0 75- Subdivision
ed Agent 46 Difrke4I(1)1441 eerti giAriHi) City / ZIP 5174.
®CW ❑EW 7 PTA ❑ES ❑PTS Phone# ( ) 1f" /� River B in Cc�r
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body/ir'/A 4�0' •l '9 fW� n/a
❑ PWS: ❑FC:
Closest Maj.Wtr. Body //44-'"
Ye / no PNA / no Crit.Hab. yes I no
Project/Activity
i ) CL4HS75"/tr// , 74
4e f/',✓ // /-'r � s�/r4i� 4�
�l-!/r,.5 /lib fin-/ 4S�/'T/<S . N <
:k)length- /304 / /,
AC X/7 A lit ep
/ ,,
ier(s)
ngth ? I is..•
nber I
i/Riprap length ;r
distance offshore L �0 j
x distance offshore F ,
i I
cannel V ;
I 1 j
-�—r_ L\ I r
>ic yards /e •, r�. /
s atlift0 2 - t•� f
/ lri%
r 1-
I 'X i2 w1 `� i /,,-/►- i —f - 7 //1
ulldozing e d
b ' Ili Li
�l
At —
{
e Length 4 t. 1 MIMI-.-.._ ���1►3_ />r�
not sure yes n \jai W i' v / i 4
It 7
s: not sure yes s '
cum: n/a yes n Z.. ' : 4._-
. t /' /L .r I /w L
yes
tttached: yes ,4 W f'1 . ' / it Ak-O iedr ' '
ng permit may be required by: N/7 eO • .7hf ('/�m s iv/7 1 I See note on back regarding River Basin
'D . I_- �v 1.1t., ! /. �r/.d , ` .- -/ _ ..f .. _

DUNCAN MARINE CONTRACTORS, INC. 15440
2725 OLD WRIGHTSBORO RD. UNIT 9D
WILMINGTON, NC 28405
66-I9/530 1C
4Y DATE__ -- z— OS-- teas
THE
RDER OFZT:44A,LcA/ / Do/ I $ 2,Q0 -O 0
/G✓O haarR'/ 1d' t',) !/�
DOLLARS 8 ,M..
Bank of America �°
IACH R/T 053000196 ' -
II 0 L 54401' 1:053000 L961: 0006968990 2311'

DUNCAN MARINE CONTRACTORS, INC.
2728 North 23rd St.
Wilmington, NC 28401 11
910-256-6620 www.duncanmarineinc.com DUNCAN
I K,:___ :.Z .�/r,, .. -T MARrNE
CONTRACTORS.INC
Dear Mrs. Hinely,
This letter is to notify you as required by State and Federal regulations that Duncan
Marine Contractors has applied for a permit modification to accomplish the work
outlined in the attached drawings.
Your signature and initials are required for the Division of Coastal Management Adjacent
Riparian Property Owner Notification form. If you would please sign the adjacent
property owner form and fax back to Duncan Marine Contractors,Inc. at(910)256-0175
it would be greatly appreciated.
Objections to this proposal may be sent in writing to the Division of Coastal
Management, 127 Cardinal Drive Extension,Wilmington,NC 28405.
Should you have any questions,please feel free to contact me. Thank you in advance for
your help.
Also, if you have any Marine Construction projects in mind we would be glad to help you
with any questions.
Regards,
Steve Swain
Project Manager
Duncan Marine Contractors RECEIVED
2728 North 23`d St. DCM WILMINGTON, NC
Wilmington,NC 28401
Phone[phone] JUN 2 4 2008
Fax[phone]
E-mail: [e-mail]

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 7-4 D,nu [��„ ., /��g 's
(Name of Property Owner)
property located at 2 '3 i Z c , 11l'6,ry
ll (Lot,Block,Road,etc.) �J
on i"/,yr' I,- �rr/C�✓e' 1(ar/,in /I/c&J Wet.,t o✓e r' euK)ly,N.C.
(Waterbody) (Town and/or County)
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/boatlift/boathouse
must be set back a minimum distance of fifteen feet(15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
<,A.
RECEIVED
DCM WILMINGTON, NC
JUN 2 4 2008
(Applicant Information) (Riparian Property Owner Information)
7a, Al a 3r°�1 ,
Mailing Address Signature
/• ) 3 - - -

' HENRY B. M,WANS HEIRS
W+W W
�ii\ r.p� W W ` W C/O TARS.JOHN 0 HI ELY
FRANK WALDECK ='( + '+ • W 8 SPANISH MOSS OR 1
228 ► NEL HAVEN DRIVE Lit 1 *W`o`•1 W W SAVANNAH,OA 31419
1MLMIN V < NC 28400 1e W ++ •+` De:Doi PO:0188
DD:2779 '(N :9 \ *\a`00A•e. W Y I'•:1�L I', a;�
up.
w „ ^3,� ,e -,A\
46:0;
t. CI
ell r- '.. c 615.63.
u p0 pp �i,/� ,Z
fi.0 0 0 o_li01%. FA e -----......_,--"'-' \
AL
A
/ ' \ O,AIr \ J
\-1- ------——2' A
\ o
' FrW'DECK
�'`� 1� 'y 3'x4' TRIANGLE
\\ ---0x$� ` 4'x10TEPS UP
\ 1538 r�
\ = \
SS
\ ��1-- \
\ RELOCATED DECK
�'� IMtn' GAZEBO WITH DECK
!V •�� \\ ELEVATION 7'± ABOVE EXISTING
ACCESS PIER
I
\ ' I' \ 30'4;FLOAT•?+ f rX L'
\\ -2 O $' \ (e'2ADDEDNG F EXISTING
0` C) ` \
\ *N Rip\F� p\ER -EXISTING \
\ w LNG r\ <AFP .___ r-
\\ END 0 EXiS . \- 2 \\ SnNG- I1NE
\ 2.y1.-+4STING ! \
\ AFT v• \
_ \ RECEIV
a\-- F \\ 0CM WILMING,'
\\ ii
\\\ JUN 2 4 2
NOTE: \ \
THIS FIGURE COPIED FROM \ % \
SURVEY BY LAND MANAGEMENT \ o .,..—
GROUP INC. DATED 3 MAY 2008 \ $ \
\ \
\ MYRTLE GROVE SOUND \
\ \

DUNCAN MARINE CONTRACTORS, INC.
2728 North 23rd St. �
Wilmington,NC 28401 y$v '
910-256-6620 www.duncanmarineinc.com DUNCAN
I v,,,,:dZILMAUMMEIZEN MARINE
CONTRACTORS,INC
Dear Frank Waldeck,
This letter is to notify you as required by State and Federal regulations that Duncan
Marine Contractors has applied for a permit modification to accomplish the work
outlined in the attached drawings.
Your signature and initials are required for the Division of Coastal Management Adjacent
Riparian Property Owner Notification form. If you would please sign the adjacent
property owner form and fax back to Duncan Marine Contractors, Inc. at(910)256-0175
it would be greatly appreciated.
Objections to this proposal may be sent in writing to the Division of Coastal
Management, 127 Cardinal Drive Extension,Wilmington,NC 28405.
Should you have any questions,please feel free to contact me. Thank you in advance for
your help.
Also,if you have any Marine Construction projects in mind we would be glad to help you
with any questions.
Regards,
Steve Swain RECEIVED
Project Manager DCM WILMINGTON, NC
Duncan Marine Contractors
2728 North 23rd St. JUN 2 4 2008
Wilmington,NC 28401
Phone[phone] x __
Fax[phone]
E-mail: [e-mail]

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to j1 Dmet.4 ( „ ,-J.4,,j 's
1 (Name of Property Owner)
property located at 2 3 i Ll, '/I''d,4 i -�` . ,
(Lot,Block,Road,etc.)
on ,/,/& eirdep✓C A)tuk./ in Vcu/ /4-)l �'Iwo)/,N.C.
(Waterbody) (Town and/or County)
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/boatl ift/boathouse
must be set back a minimum distance of fifteen feet(15') from my area of riparian access unless
waived by me.
" /4( I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
RECEIVED
DCM WILMINGTON, NC
JUN 2 4 2008
(Applicant Information) (Riparian Property Owner Information)
7?$ /1/ 3" 11
Mailing Address Signature

u^
. . . . . . .
+� ` + HENRY B. 1NWAUS HEIRS
;, +++ ++++++ `+` C/O 11RS. JOHN D HI ELY
FRANK . WALDECK f + 8 SPANISH MOSS dR o
228 NEL HAVEN DRIVE t.f� ++++`+ + SAVANNAH, OA 31419
WIMIN NC 28409 ��a, ++++,+�y� + DB:0901 P0:0188
DB:2770 GGu 480 ,.+y 00A... ••y E SN'L i't e1J E.I.P.
+ v/ .\ 15
U. `.1 ` e$ti6 E 11N
,
n� /6r 0�• ' ✓ �� S M L4 .
it 4z 16 C—� r� 3\ '^S
•
r //
'SI
— \ k
1445 At,- SA1
`: \'a
row
/ Co ON ' r \
\ L— ss. 1 6,--
J
ss
\� r \ SW'DECK
\ ' 1 '' ' 3'x4' TRIANGLE
0� % kNt -1 ` NEW STEPS UP
$ 4'tx10't
\ T
.8 J \
\ __-.1 %: \
RELOCATED DECK
\ i 18'x20' GAZEBO WITH DECK
` , \\ ELEVATION 7't ABOVE EXISTING
\ U111rr I� \ ACCESS PIER�1
\\ —2 O r ` (6' ADDE D TO EXI'Nis,,l6'
24 LONG FLOAT)
\ HMO. O \
\ r,R p\ER \Fik EXISTING \ ��
\\ FAO �t S.GNG �\\�- R ryry-_.-.-\ 9TING PIES uNE
5• \ HElD
\ .�' \ E%I
\ y6� STING -� \
\ \
\ f \
.3,— RECEIVED \
\ �- DCM WILMINGTON, N4 \\
o
\ y JUN 2 4 2008 �A \\\
NOTE: \ . \
THIS FIGURE COPIED FROM \ °A \
SURVEY BY LAND MANAGEMENT \ o \
GROUP INC. DATED 3 MAY 2008 \ $ \
\ \
\ MYRTLE GROW- SOUND \
\ \
.Infirm A-n nu rn 1,rnvmmin A on A \ \ _-

SENDER:COMPLETE THIS SECTION COMPrETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. gnature
item 4 if Restricted Delivery is desired. X l� i% Agent
■ Print your name and address on the reverse ❑Addres
so that we can return the card to you. D. calved by(PrintedName) C. ID to of eli�
■ Attach this card to the back of the maiipiece, a eP I; �
or on the front if space permits. t°i
D. Is dollvory address different fro item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address elow: ❑No
/vjq , t5ittvt b. / vt
3. Sery
yr y1 t`ki r/<,G` '3)`/ ( �ertiflediceType Mall ❑Express Mall
❑Registered ❑Return Receipt for Merchant
❑Insured Mall ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Nu 7007 0220 0003 7190 3720
(transfer f
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-
SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Sig e
item 4 If Restricted Delivery is desired. 0 Agent
X
• Print your name and address on the reverse Air_ r ,, ❑Addre:
so that we can return the card to you. B.(!:le clued by(Printed Name) C. Date of Deli
■ Attach this card to the back of the malipiece,
or on the front if space permits.
D. Is delivery address different from Item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: Cl No
f J4 )L&J ,16-e-
I )1
// 3. Service Type
7t' ?f VC l/�g Certified Mall ❑Express Mail
❑Registered 0 Return Receipt for Merchan
❑Insured Mall 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7007 0220 0003 7190 3737
(transfer from ser.
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-
RECEIVED
DCM WILMINGTON, NC
JUN 2 4 2008

• LAMA / Ii DREDGE & FILL. 4 ��
GENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
horized by the State of North Carolina,Department of Environment and Natural Resources '/
e Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7/T i/244
rY a ,. 'Rules attached.
ant Name ,tS f 4- /t 0 . Project Location: County //€tv g ,yrel�/,,
ss fa3C_ ?r•i �, _}_ Ke,4 _'i'.'61 Street Address/State Road/Lot#(s)
# (_?fn) ,$1?,p / Fax #(y/o ) I/57o t> Subdivision r'
•
rized AgentLee `�i s% t��r C _ L„ ':^j City 5�•�-�f ZIP ,
ed VCW Y6v IA ❑ES C PTS Phone# (- ) 5, -i t - i, River Basin (74
O OEA ❑HHF ❑IH O UBA O N/A ��>(*wit.
): C PWS: ❑FC: Adj.Wtr. Body y/',/' (ern', '5"os/ •
yes no Closest Maj.Wtr. Body /tea P/'' r�"/•vi C ''T•
/ PNA yes,/ no Crit.Hab. yes / no J.S�6Irvr
�,f project/Activity Ci, 5- t/Gyj f i4 CZ r'i i7 I'Y CoY',-c/,a /!r7
f �60�r f/r rfs
ll471/n� 171 (Scale: '_
'dock)length jSY.k G /
(5) Mtn •r,G ENOMME .■ ..�....�...� -
...®®® ... B. �[�
rpier(s) *flit
_ ' I .�■®__. ® EEO '
i lengthI �jGal� �... i i Ill
number A t. d..�.�� a .�.. I i I ..1
lead/Riprap length al l t� ... t/ri®�':a...N....N..a�i
av distance offshore I A nm ..� �.�i■�■■.RU■■y!)
max distance offshore 1, F . �.� .��em.i.. .mo
channel mirmrA �tionmag-a'�i �..l ii�....�...n......
cubic yards Wi����il�� ..M11...�.. I i ...�
ramp � .hrd.i.....� ..............l
louse/ oatli �1 . ...�...!'�7�..�.. ..
.a� gra ........ ...e.. im
/2'x j2. ' NI:Ni ..U.:... i...UU..■ �, .� • .- . -4-
1 Bulldozing . .... ..
r /�/ ti .1a� ,aes..�.UR..... Ii...mi.•U 1, t--
.....�E.■.......�� 1
y'k ' .1i..... .. UM ■■.■.
.......C.r �f..L.a.l����mE.....M5 i Tit,,_;i .NES. 2
line Length—
,._ NlaeINIIIMIIIMIDLIikillMilnillr._MntllMIMIMIMIMIMIIIMIIMIMIIUII
.�.minir ikori��1�.... .. i -, - -Awns
s
not sure yes n ..0 _aU.�remit l �L _ �� �
in�Viinr/S MIN _linaiiila�. �i
sags. not sure yes - 1 afira �zio
min
tonum: n;a yes J t' !, 111 ._-.�- E.9. r Wr �.
tai
ss: yes j_- r iKg �. 114gM ��:�_.='
er Attached -__y yeses /fiol .�1 X i
Iding permit may be required by: /1/,/eGi. /_97/V///9:f . See note on back regarding River Basir
s/Soecial Conditions 2it/1,//e , _'/9./�/, /J,9r1/, �f L'-/if-*f/:- .-4 J �Y..i2/

COL•Alic.7.‘ A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
I F.Easley,Governor Charles S.Jones, Director William G.Ross Jr.,Secre
Authorized Agent Consent Agreement
e/h/2 l Unrc, J� ov4JCA/3///Afew' a 4, is hereby authorized to act on my behalf
(Printed Name of Agent)
r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to th
: activities described in the attached sketch.
'ION OF PROJECT:/
> C GtJ( /�/43r,'Zc k X
1,77.7//Br,/ AJG. 2g4te 9
RECEIVED
DCM WILMINGTON, NC
ERTY OWNER MAILING ADDRESS: JUN 2 4 2008
/G/,i;c/ ��'/ N e •284/.z PHONE NO. q/D
?RIZED AGENT MAILING ADDRESS:
rC►a tJ }�12 t N Cy�r.—i t -0� o`z5 , kr
2S IQ . 232d5i
t Lam . . 2e40 PHONE NO. .910 — 2c/
Pure of Property Owner.
Pure of Authorized Agent:

CAMA/ DREDGE & FILL Nil 4
iENERAL PERMIT Previous permit# o
1ew Modification L 'Complete Reissue ''Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources IA/ , / v 0
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC v
...... �Rules attached.
:Name ��c.) �t F C 1 //"(Lit6t�� Project Location: County /tie� firiedertrie
?i / it). 1,1iL , /W/2 lit it Street Address/State Road/Lot#(s) /p‘,..),j 451
1(7.0G1(<44F ) 6f0 State A/C ZIP .492-f AO (' ,4 - 1/, •
(9/4 413- - Fax#( ) Subdivision
Bd Agent 7, '(//D C. CSC!,i?/ L,/oNey . City i„�/ _ ZIP
❑CW N.Bi// [1;441A E ES ❑PTS Phone# ( ) S 1River Basin CI��
E OEA ❑HHF E IH E UBA C N/A Adj.Wtr. Body(' (/A Wf �//�N (nat
/ nat
❑PWS: ❑FC:
des / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body /4y��
Project/Activity M'Z)/f-, "0"ice O i'M Q , - F)C1,57"/ f] C',,L A1/4)Z7
m,c4cax e- rwe/L/7'y' rd /Ai C G ee 4' 'WAN% (1#47GCF (Scale: /
:k)length r/2��,G-/
(s)
er(s)
igth
nber _. __ __ _ _ —r t9J~
I/Riprap length b r �e`� ✓e-C14
G
distance offshore I C
c distance offshore 4
annel 30 iX J�� Q.
....
is yards it& Q 3?
ie/Boatlift - 'fra` _ _ 2 Sed I" / v
' ' e '-n ,1 P' --Xc14V,4-r'rZ7
illdozing , '4 e
a
a C
Length > 5"�j
/ u
r
not sure yes ,C.i.'"c'g a ei D I
not sure yes
im: n/a yes
yes
ttached: yes
ig permit may be required by: ( 1,V 0 See note on back regarding River Basin ru
A _ . ! _� I I 1 w' --

'4
48202
0 TOWN OF CAROLINA BEACH BB&T
_ 1 121 NORTH LAKE PARK BLVD.
n Branch Ranking and Trust Company
_�z. CAROLINA BEACH, N.C. 28428 CHECK NO.
910-458-2998 66 112/531
1
RFP
• 48202
Hundred Dollars and 00 Cents y
a
DATE AMOUNT
m
08/21/2008 $400.00
CENTRAL DEPOSITARY TOWN OF CAROLINA BEACH
:OAS TA L AREA MANAGEMENT ACT
Mrovlsion for the payment ot'^is(Mock(or draft)has been made by an appropriation duly N
made, uant to th J..ocat Government Budget and Fiscal Control Acr
127 CARDINAL DR EXT i 8
Devi
VLMINGTON NC 28405- �tNANeeoFFtceR sr
530 (Ai ) ��**3
11'048 202116 1:0531011211:000 5 2 1 589 746 i11'

i
,P, -- REMOVE A PPRO �c - �50
I 'r =. o.. 0 / 5 Po IL . .t.>r 6 0 m S„1�/r ,
Ir� , c ,,t C A C4, /N 4 i5 F. t, .'. fi,. A ,1.
5 p 0 i 1 1.,tif / 2-2... e: . : S 1 ," 11., T;:- cd c'
I r' 1t419 O P 5 7 y/ &asic t.CcIcv -frc.atviett.-j
H-1 .._. REAa;A5 IV 34° 0 1 . Ss 1 /W 770 51/. $81
i<-- 6:31! o
I 1 Sz /es 1
i
tz- I 6 I I
0
can ,6 I •
I--1- I a m ) _..-
1
0 j `'ti ,.,' ‘ 1
°Li
I a -.na c 1 I 1
I G � .s a� p
, 1 1._J---2 \�fia I. I _

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F.Easley,Governor James H. Gregson, Director William G.Ross Jr.,Secretary
Date q' 11- O
Name of Property Owner Applying for Permit:
Mailing Address:
//.2/ /✓o 44,E datie Ea&
1',,4eeku 3e-4eA, &vc. ?ivv&
e /o- 4rs1-$5oo
I certify that I have authorized (agent) Dim e (SK.ee9) er to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) n•naavA..l ¢ Jreit-Prb. (Ar,i,, Bold, 4/It : 4•6D7,
at(my property located at) %vwi, n I' 6/zo%;h., &F,4C4
This certification is valid thru (date) e. '/ 26o4

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
vvain.-,
I hereby certify that I own property adjacent to —row c C'
(Name of Property Owner)
property located at 1/ v N4 L,t ke �,4,-1c 7gL v0. ~$Mae rn s S cQ
(Lot,Block,Road,etc.)
on FY)r14'k G roV C So r Lnn , in OP w 4,,, 301-cl► ,N.C.
(Waterbody)�7 (Town and/or County)
Applicant's phone#: 7/0•Ki-$53/0 Mailing Address: 112!ALA Lake P,ivK ELVO.
3CAU, Aic Z842$'
He has described to me, as shown below,the development he is proposing at that location,and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying (Riparian Pr Owner Infor tion)
for Permit) nn
//i/ 4ar4 LICE /ArX 1-1/b.
Mailing Address- Signature
7;i&� L��,. /U C 711l2V tr %R EF V c

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to r, ' 's
(Name of Property Owner)
property located at z/5- 6tiA / AZ/vt' - gieh,r in'is(crs s4.
(Lot,Block,Road,etc.)
on rif// /11t ( ove. So ail ,in Cl4 ro 1,n c. 3t AC1 ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#: 4/6-Y '2SWQ Mailing Address: Jp// Mar-/h. LAKc Ark
(`Art lr.�A �G Rc�r /ti! iff(.2 7
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/boatlift/boathouse
must be set back a minimum distance of fifteen feet(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 not wish to waive
I to wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) n j�
A1`:, 4� Lrak Pflrk &sib
Mailing Address Signature
C-AYch;.A Rota NL S2€ 1 6PtCA `1