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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:Address of Property: Loy , i`tc`
(Lot or Street #, Street or Road)
1:44 ind-C r ,00 rri
(City and County)
f
I hereby certify that I own property adjacent to the above-referenced property. The indivic
applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should be provided with this letter
I have no objections to this ro osal.
P P
If you have objections to what is being proposed, please write the Division of Coa5
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 objectioi
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
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If y
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. \, , ow
evot
I do not wish to waive the 15' setback requirement. �cul
^
//-710
i gn Name ate
Print Name AA

19/2006 07:01 FAX [phone] _ _--• KINKO'S IVILMINGTON,NC Z 002/(
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