52071D - Clark

''CAMA / DREDGE & FILL -•
GENERAL PERMIT Previous permit#
L Jew ❑Modification L.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 SA NCAC 7+-1 • 12-00
I Rules attached.
nt Name J A 1 . (_L./ 4— Project Location: County t � l.1►�LAD I CA--
s 1 ( L.i c (.Ct212 j 1.:-< Street Address/State Road/Lot#(s)
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#(-'I 1.) (5:c'( ,-2S `$10Fax#( ) Subdivision
ized Agent City ,:75- ?-n+ )CT ZIP 7k
d E CW EW �;-PTA _ES ElPTS Phone# ( ) River Basin ( AA
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• Adj.Wtr. Body ( / f't; Z nab
_ PWS: ❑FC:
yes / no PNA yes no Crit.Hab. yes / no
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(Scale: I/,:-
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umber I I
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vg distance offshore _ r ,.� 6,15i „....•
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Attached: iye5 no 1 31 Er. i
ling permit may be required by: 5:)(ff-k fber I i See note on back regarding River Basin i
i c___:_,i^___..:__- A. . ! . IN ,_r .a \t 11\. 1 L1 I ) .-1 1 I r'-_ .,a-1 L -,A.<<_ r—n--., ..

JANE M. CLARK 16 21
ONE CLIFF COURT EXT. 692-8286
SOUTHERN PINES,NC 28387 6 _ 1 '7�-?
,,,�// DATE
1 -'V-'$ .6Qcv Q24111J
iPAY TO THED /(�
r ORDER OF ' / I $( �
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i RBC
1 '31Century
RBC Cinema Bank
I:0 5 3 L0013504509 300 26 2911' L6 2 L

N-05-2008 09:49 From: To:9102952810 P.10/12
D1V[SION OF COASTAL MANAGEMFNT,
ADJACENT RIPARIAN PROPEI.TY QWNE'RNOTI 'ICATION/WA.IVER FORM
Name of Individual Applying For Permit: c. _ __ G /G�
Address of Property:_ � ��
(Lot or Street hi, Street or Road) A
____—<e;tdA7 ,1,-/---ti
(City and C3"ounty)
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 t
are proposing. A description or drawing, with dimensions, should be provided with this letter
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 objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breal.rwater, boat house or boat lift must bl
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 1 3' setback requirement.
I do not wish to waive the 15' setback requirement.
.� - .. rf �:c &toze‘
o%
crn Name Date
�(Ff9,t1NF �ie� cd, SeaoL d AWKIrA

IN-05-2008 09:49 From: To:9102952810 P.9112
D[VISION OF COASTAL MANAGEMENT
ADJACENT PIPA JAN Plt.QPERTY OWNER NOTIFICATIQ L AIVER FORM
Name of Individual Applying For Permit: 4 J 4"- ()tar k
Address of Property: z 3, 7 L= ' aai $freel— W
_______
(Lot or Street#, Street or Toad)
(City and Cotlnty)
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 t
are proposing. A description or drawing, with dimensions, should be provided with this letter
V T have no objections to this proposal,
P p
If you have objections to what is being proposed, please write the Division of Con
Management, 127 Cardinal Drive Extension, Wilmington, NC 23405 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 h
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 13' setback requirement.
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Name 18111 Date

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