49240D - Sherman

CAMA / DREDGE & FILL
3ENERAL PERMIT Previous permit#
New Modification Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 71-1 ?DO
❑Rules attached.
it Name 1 1 6 (. 1 e y ma .LAProject Location: County C AS`�w
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t( ► oLoq-Loq IFax#( ) Subdivision
Eed Agent City SIOLSM ZIP AS
❑cw A'TA ❑ES ❑PTS Phone# ( ) River Basin 'P'
❑OEA ❑HHF ❑IH ❑UBA ❑N/A ��n
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yes ' PNA 0/ no Crit.Hab. yes / no Closest Maj.Wtr. Body � Al
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not sure yes no -- ,t fts: not sure yes no , \hi-ium: n/a yes no 1— ! — `J_
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Attached: yes no i
Ing permit may be required by:0 t 1 T 6 Ji'i �t1't 1 );l V- " . I I See note on back regarding River Basin r

MICHAEL J SHERMAN 66_ 1 113 7
LIC.8563074
031 PH.919-963-2908
P O BOX 1322 � `'1 •
FOUR OAKS,NC 27524 DATE
^ `
PAY TO V\ I $ XOo1
THE ORDER OF \ q
Y\�1rnC DOLLARS
FOUR 1912
OAKS For i sh°`i 9- z'son Cat ebarter
ClubB. Toll Free 1-877-963-6257
MEMO aos \\(6/ w
1:0 5 3 /0 50 591: 03131, 63606 1'

Aug. 7. 2001.; 3: 29PM IN T HUMPHREY1ERnAn tsts) 963-\2.l706 P. 2/2p 2
DIVISION OF COASTAL MANAGEMENT
ADJACENT F1PARIAN PROM; j.Y OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: tCV 1 (1,12c,p 5 S\'‘e f t�qh
Address of Property: \ � 1 �a.rXo.. SA-
(Lot or Street#, Street or Road)
(City and 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.
_ X . I have no objections to this proposal.
If you have objections to what Is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
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,boat house or boat lift must be set
bck 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.
WljtV1 0/266 1
SionDate
Print Name •J ACCIrA

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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. X 0 Agent
IN Print your name and address on the reverse ■ Addressee
so that we can return the card to you. B. -eceived by(Printed Name) ��� '
• Attach this card to the back of the mailpiece,
or on the front if space permits. �V14 N / Q
D. Is delivery address diffe nt from item 1 0 es
1. Article Addressed to: If YES,enter delivery address below: • No
\- �
1
61564�,/� 3. Service Type
0 0 ❑Certified Mail 0 Express Mail
❑Registered 0 Retum Receipt for Merchandise
❑Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7002 2410 0006 8933 6685
(Transfer from service fat ,
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540