49102D - Medlin

VIA/ ❑DREDGE & FILL Previous permit#
NERAL PERMIT Date previous permit issued
❑Modification ❑Complete Reissue Partial Reissue
3y the State of North Carolina,Department of Environment and Natural Resources LI Resources Commission in an area of environmental concern pursuant to I 5A NCAC • les hed.
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Project Location: County
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C311-
; �._.. Street Address/State ad/Lot#(s)
GZl State�C/ ZIP-t' "
Subdivision /1�S
k ) �Fax#(_) G�'� ZIP I--
City��►'� /t �� �.
River Basi
Agent Phone# (_� GA '
ES �PTS y �....4.56 (nat man
D 0E 0 IH ❑UBA ❑N/A Adj.Wtr. Body DP Z
OEA ❑HHF ❑IH �✓.✓��
PWS:��
DEC:-- Closest Maj.Wtr.Bode
-`, PNA yes /tp°. Crit.Hab. yes / no j O , wr
4-ject/Activity CeT (Scale:,
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iber 1■
I Riprap lengthy Num ' +� 10 1 ,
1111111Mlinimil MINilk g-
distance offshore c _ ...
K distance offshore —i :� �_
cannel \ _ --
r 3.
s PS
sic yards j 1
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use%..____ ii in - ti,,
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3ulidozing —_` a -
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line Length
not sure yes or •
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lags: not sure yes al- _ , P
torium: n/a yes :�
as: eser Attached: no El See note on back regarding River Basi
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AMOUNT
_. .,_.._------ ----�" -_ '---- EXPLANATION 66-1220/531
_______............rll
ISLAND REAL ESTATE 3 =� 3 8 01
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GENPRBo A690CCO 05 ROLAND AVE.UNT V .
SURF CITY,NC 28445
CHECK 8
AMOUNT
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DOLLARS
iNi{�� CHECK NO. ��
l /�Vv DESCRIPTION
TO THE ORDER OF
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' , CATHY G.MEDLIN
VOID AFTER 60 DAYS
CAPE FFARBANK _------ -- -
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0003 80Le 1:053L122041:000009L40511'
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DIVISION OF COASTAL MANAGEMENT TIFICATION/V�'AIVER FORM
ADJACENT RIPARIAN PROPERTY OWNER N
Name of Individual Applying For Permit:
Address of Property:
(Lot or Street#, Street or Road)
- g_A-- a -(-' , /fte, Afj,eX- (-4,1r7
(City and County)
own property adjacent to the above-referenced property. v The
indiv
n env
I hereby certify that I 1
applying for this permit has described to me as shown os attached drawing the
should be provided with this lett�
are y g
are proposing. A description or drawing,with dimension' ,
'14 . I have no objections to this proposal.
LIS
If you have objections to what is being proposed, please write the Division of CI
Management, 127 Cardinal Drive Extension,
Wilmington, NC 28405 or call 910=7-I c
of receipt of this notice. No response is considered the same as no objec
within 10 days p you have been notified by Certified Mail.
WAIVER SECTION
dock, mooring pilings, breakwater,
boat house or boat lift n
I understand that a pier,set bck a minimum distance of 15' from my ri
parian of ri arian access -unless waived by i
you wish to waive the setback, you must initial the appropriate blank below.)
N S I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
V . , d* q - il- ol
Date
Sign Name AlA

DIVISION OF COASTAL MANAGE MEN
F0
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
RM
ame of Individual Applying For Permit:
ddress of Property: 7 7
(Lot or Street 4, Street or Road) Avier
r�
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individu�
P
e
applying for this permit has described to me as shown on the attached drawing th ded with o msent E
ro
are osing. A description or drawing, with dimensions, should be prove
p p
/ I have no objections to this proposal.
lease write the Division of Coas'
If you have objections to what is being proposed, p ��
Management, 127 Cardinal Drive Extension,
Wilmington,
NC 28405 or call 910=�1
ecei t of this notice. No response is considered the same as no objectio)
within 10 days of r p Certified Mail.
you have been notified by
WAIVER SECTION
I understand that a pier, dock, mooring pilings,
breakwater, boat house or boat lift inns
set bck a m inimum distance of 15' from my area of riparian access -unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
�f I do wish to waive the 15' setback requirement.
I do_not_wish to waive the 15' setback requirement.
D to
Sign me
A! A