49239D - Miller

]C„AMA I Li DREDGE & FILL
3ENERAL PERMIT Previous permit#
1New ❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources '' 1 i -1
:oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC,#•'( • 1
^� ' Rules attached.
t Name Zk.; j 1 LLC/. Project Location: CountyS l.i,^- -_
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ed Agent City 'V 441 1LAc 1X ZIP 0 /j
❑CW t EW _ETA ES PTS Phone# ( -- ) - River Basin/.
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um: n/a yes no.) ► .�
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ttached: yes no i I
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ig permit may be required by: IYpI,�`CN, ,OQS,,,'IL Q t,A< I See note on back regarding River Basin ri
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rl{ l�l �'� r�r F & M FARMS, INC. 2574ii
�' f♦ / '/ 764 SUMNER RD 910-298-4935
V `\ V� V l�f�:,/ PINK HILL„NC 28572
'.'/A`, /\` /',` ljt�,'` i- / -7 66-30/531 ;
% / / / j / DATE
i PAY •• � /
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FIRST CITIZENS BANK
/wwww.firssttc�itiizens.com-
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,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
(� e
I hereby certify that I own property adjacent to fl4 S L� 11,,Q_l 's
(Name of Property Owner)
property located at P•V4 � (1). -i
(Lot,Block,Road,etc.)
on S n SOtic , in Mur�� 1 Ai' 1 , (nS ltlw ,N.C.
Igo
/Waterbody) (Townd/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. (If you wish to waive the setback,you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be led in by individual proposing development) '
a
r1/40
/67-`17' 4)/1
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Pi ea sa► l-v►1 le L C 's
(Name of Property Owner)
property located at z)`i
(Lot,block,Road,etc.)
on S+u►-np SotA.y4 , in j\Ll.a\\ 66\5LLcj ,N.C.
(Waterbody) (Town ana/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. (If you wish to waive the setback,you must initial the appropriate blank
below.)
/ I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
e
•
M
pel
et LCt.i.Jlc.i —Pt ea Selyitvi I I E
Signature
�� �: _ _ 1 .. ._ I