43997D - Ellsworth

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3ENERAL PERMIT Previous permit#
4:New Modification Complete Reissue -Partial Reissue Date previous permit issued
-ized 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 --74, I Z4:Zg:
les attached.
'!'�N
t Name ri.11p Ny & LL 5 v,/ �Q1 Project Location: County P� z n..
I ' 5 Lyt`AA C2-y a t-"S-\ \ / a\-' Street Address/State Road/Lot#(s)
Ni-rNQsc c taD Stateld I ZIP ti3NN-5 L.ol Z I ‘2a►..) ?02‘../T �
(cCk D) W 3- fl 0 Fax#( ) Subdivision PA ALI..Ova.17 `1 Ate'
ed Agent .\J-1 1(04,1,..-1 N t City •Dkm P 0-;( e c _ ZIP Zg t'I
cw )tW y.,PTA ❑ES ❑PTS Phone# ( ) River Basin ?c
OEA ❑HHF E IH ❑UBA ❑N/A Adj.Wtr. Body
PWS: ❑FC: tit. AA ii.7 v¢-Et at i
yes / PNAi no Crit. Hab. yes / no Closest Maj.Wtr. Body I'`Z )1/
Project/Activity kJ x 1) ' Z t,�� L,,- ) ?j`-�1 X 1 2' -i 46 ac- L I VG2 L-a
`7v '1— r✓ SC-C t (Scale: j -
:k)length b' X
(s) 1. x i t
ier(s)
igth E _
nber - _.
i/Riprap length
distance offshore
x distance offshore
cannel
-- 1 1 i
sic yards �_�`�
_.
i
se/Boatlift 1 � {��
1 ' i
illdozing �� Ed !L
a Length ,am, ,a I , t
not sure yes -no ._ __ .IL
not sure yes Q T --"—
um: n/a yes _ 1
yes Z.)c�
1tached: yes no.� - —
c
1g permit may be required by: ? � 6 3 F I See note-on back regarding River Basin ri

I.
ANTHONY P MORRIS 1413 .
A&T MARINE CONSTRUCTION
131 Roberts Road hh 67-219/539
+ Hampstead,NC 28443Z-)\V ls M""C"o"" Y
` A DATE C`J
PAY TO THE N�IDC,Ni/ I $ S�
ER OF
Y J-Z_ � �-- : DOLLARS 8 ' @
T IF 1
} CAROUNA FIRST A
S`TEAAD—NC 228M3 i/ / ccc,- ��- y/�\
FO Q A, 6 P T 34 l(. �/ `"1 \ ' M'
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO 11FICATION/WAIVER FORM
Name of Individual Applying For Permit: 4Avityvy eu-sv)oeirtt
Address of Property: Lore 10 Z I c +r. Af^rr-E-
(Lot or Street#, Street or Road)
M4.,Ps7 i> Nam- ZSket 3 Dew- co,
(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.
If you have objections to what is being proposed, please write the Division of Co.
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-2
within 10 days of receipt of this notice. No response is considered the same as no objectii
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must b
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.
4 - I do not wish to waive the 15' setback requirement.
Sign Name / Date
/ c',4,P,t7 - inz,eJJ ✓
Print Name AT �

.
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: i9 No^"Y e7-.s44og-r H-
Address of Property: 4.67— l ' 2/ C *I"C PD1•rrC
(Lot or Street#, Street or Road)
M-44 P s7 't'i:. "le- 211443 frrVDaK. Co.
(City and County)
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 des 'ption 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 910-395-3
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, 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,
wish to waive the setback, you must initial the appropriate blank below.)
/ I do wish to waive the 15' setback requirement.
t/ I do not wish to waive the 15' setback requirement.
// • ,--)3,7 A„1
Sign Name at
Z-` ,"r /11-P/°)?
Print Name AT;;A

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