52100D - Hendrix

CA AA/ ❑DREDGE & FILL . ,
EN ERAL PERMIT Previous permit#
New El Modification ❑Complete Reissue I]Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources y�
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7/7 /2,O 6
E Rules attached.
nt Name/?,9 )L I/o,.,cht , X Project Location: County 0_0.,-i1
s 9 2 4 7 AiOd D S L,c/j 4.9 's 4 Street Address/State Road/Lot#(s) 11/ 7!i,.r,
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ized Agent .5/la t 1''- < j7)4A , . c City/7O/do... 6 09c-1, ZIP 2 F-
d L Cw EW 5-PTA DES ❑PTS Phone# ( ) River Basin L Lim
❑OEA ❑HHF -I IH LI UBA ❑N/A (' '%/ !t/
❑PWS: ❑FC: Adj.Wtr. Body nN# ( (nat
yes PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body ' //4141
of Project/Activity Odd got-)/t, 1. )o L )( I57'/e j el902 ,✓A r v/ /P6lt. �C'
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ine Length 3—V / . 12 i
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r Attached 4 no / A j
ding permit may be required by: //O L/1� �P gOp� U See note on back regarding River Basin
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: /,JA,,,,,� / He icir,x
Address of Property: ,,7/" T��q 5 -
Alo Se4
(Lot or Street#, Street or Road, City & County)
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 letter.
II have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City,NC, 28557 or call(252)808-2808 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
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags
must be set back 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.
I do not wish to waive the 15' setback requirement.
(Applicant Information) (Riparian Pro rty Owner Information)
Sdy Y;;// %-) J / )
Mailing Address ( atu
Fcye75�F,4° rLC 2Y5cS 7 k - t'Dt/ ii
City/State/Zip Print or Type Name

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: f�� f'?G ,,t�'n /�1�� i++,nor;
l f 0
Address of Property: !l/ 7cinc, 54:
/0/rie, Rend, C
(Lot or Street#, Street or Road, City &County)
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 letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management,400 Commerce Avenue, Morehead City, NC, 28557 or call(252)808-2808 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
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags
must be set back 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.
I do not wish to waive the 15' setback requirement.
(Applicant Information) (Riparian Property Owner Information)
5-0 Vc//eY
Mailing Address Signature
e e //c //..C_ .2 "105--
City/S ate/Zip / Print or Type Name

A.L.A
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 -/O $�
Applicant Name /% /�G.,c4eX
Mailing Address ' ?(D) LJot b End lc,
A/ „2r27?
I certify that I have authorized (agent) 5Ivreine Pi riv)t to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity)
at(location) l// /v/1c SX M cler, 6ecck
This certification
j is valid thru (date)
Signature ;' /fZA