52073D - Perry

�CAMA/ ❑DREDGE & FILL „3
GENERAL PERMIT Previous permit#
a-New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
>rized 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 '9/> 0 /ZOD
y r r Rules attached.
It Name /' , l'►�4jitiro1 e yy Tr. Project Location: County /Vr 4- /y.7ly/r�2D Wilt fl� t' f Street Address/State Road/Lot#(s)
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State �1t ZIP Zit/AI!/ �..--/-+-rre•
(9hi ) bf Fax
38k� Fax#( ) Subdivision
zed Agent City S'/74'i+ ZIP Se-2 i*
i I]CW EW _7.,PTA ❑ES ❑PTS Phone# ( ) Sea. -e River Basin ( ela.
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❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body Elt.7.E 5 7/�tiry / (nat 1
❑ PWS: ❑FC: /1
yes /:no PNA yes / ..- Crit.Hab. yes / no Closest Maj.Wtr. Body t' t i' v/./,l St"nt+
f Project/Activity (Ads fr!„t'rliti. Q7, !Ji%✓ ',,v fi---1s-/ 71
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ength
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Attached: yes 3 (��l` ——1tj1/�/yj � f�`� .. ,A 1' 7
ling permit may be required by: toe/ t`t'S►/,/i/ Bt,f l4 n See note on back regarding River Basin 1

'rotor
R. 7768
66-21/530
h,NC 28480 / BRANCH 50004
3 _!O -0 V Date
(_17 $ aZO tf.-4.
Dollars • d.:"°"
HOVIA
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: A, /r Zj e-{
Address of Property: 9)-0 jJikcJCS
(Lot or Street#, Street or Road)
/It /3ck
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lette
I have no objections to this proposal.
7wt i- 6_v$
If you have objections to what is being proposed, please write the Division of Co;
Management, 127 Cardinal Drive Extension, Wilmington, NC 28403 or call 910-796-'
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must I
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I
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.
Sign-Namc Date
A - r A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
rlsrame of Individual Applying For Permit: A 1- -P{ ��R�Y
Address of Property: 9 2O f 7`f S (R
(Lot or Street 4, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individi
applying for this permit has described tome 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 objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakter,boat house or boat lift must 131
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.
Sign Name Date
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