43350D - Generation

'CAMA/ DREDGE & FILL 1
3ENERAL PERMIT Previous permit#
Aew Modification JComplete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources r7
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC !J/,/2 dQ
[ Riles attached.
t Name ed"4/74'4,,, 2N,C e/Pe2_f Project Location: County JR u r l w,d k
F 93 y 2 1 f G r 7) , , Street Address/State Road/Lot#(s) / )- el,,,,,,,./
0 ,t✓y State:A/C ZIP 2, 7 3/0 L r .
(3.36) 6 9.? -4,73-4 Fax#( ) Subdivision
ed Agent I'd yy f;9/1M002 City 'o.7.-ESL p 8PAL1-7 ZIP 2 PYV
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ng permit may be required by: 6'CPA,✓ 1 s 1 e ,6 f,2C 4 _ See note on back regarding River Basin r

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GRIZZLY BEAR
STEVEN T. FARMER
TRA COM SERVICES 2993 j
PH. 910-754-2725 • •i
04
897 MIDDLEDAM RD SW ) - 66-112/531
SHALLOTrE,NC 28470-5657 Pubr D 62401
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PAORDER OR A/C 74Vi Si� !f AJ-t � ie.c(ev4.'S 1 $ pq`'Q V
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r SHALLOTTE,N RTH CAROLINA
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: AMov4404 a,hiap
Address of Property: 1_07- ff f / '/s ) li9iiYi��L[s,C STr�
(Lot or Street , Street or Road) J
UCP,9n ._r Sly L4Cf/ JJ Ro- 41 w.cic 64..)
(City and County)
I hereby certify that I own property adjacent to the above-referenced_property. The indiv:
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
9-i-- I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coy
Management,. 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-:
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 Iift mus
set bck a minimum 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.)
I do wish to waive the 15' setback requirement.
iL- I do not wish to waive the 15' setback requirement.
../4-7(4' 11'1—
)-v;sign Name Date