45917D - Golanoski

JCAMA/ DREDGE & FILL d
3ENERAL PERMIT Previous permit#
New Modification ❑Complete Reissue C 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 7/1--/ , /0 e d
f [ RtiTes attached.
t Name, ' ,d r/e 1 h CI`d t A"/gore i Project Location: County e2 rf,.•S c✓,G4
e D. 6 D x I U G A Street Address/State Road/Lot#(s) / S' 6,9,
eiI04,C , - State/VC ZIP 2Yyt`y .2--it S. O.
(///) a 2 Y-j 05kifax#( ) Subdivision f j j/P/L /L.L 3-
:ed Agent /n M v PI/ I-Z— City SA,9 (1 0/7le ZIP 2 T y
❑CW VW' LA ILLES ❑PTS Phone# ( ) River Basin Gc/,y,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A /
Adj.Wtr. Body,��7s ` 6v'1'0' /eil/N� 6.1)/1
PWS: ❑FC:
4-1 41
yes / o PNA /./no Crit. Hab. yes / no Closest Maj.Wtr. Body y
F Project/Activity ,a.I iik le v ' #rt,J a ck
(Scale:/ ''
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distance offshore t 6j wC
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ise/Boatlift te% —+
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not sure yes f
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s 41: not sure yes
cum: n/a yes ,n T t _ g9-
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4ttached: yes 0 I � 1 i I

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
lame of Individual Applying For Permit:44/We"TL( t.e fo s`/
4
address of Property: q(o S ge3,4 L z 5/4116C__ IL,0
(Lot or Street #, Street or Road)
Bitusit.sc..u‘ cie_ Z cc_ o/ Z
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individua.
pplying for this permit has described to me as shown on the attached drawing the development the)
re proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
f you have objections to what is being proposed, please write the Division of Coastal
'Ianagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390C
rithin 10 days of receipt of this notice. No response is considered the same as no objection ii
ou have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings,breakwater, boat house or boat lift must be set
ck a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
rish 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.
GEC, 5,4.ill
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ion Name Date Q - 706 D. p 4u0023
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,ry of real pr rty found within this jurisdiction, is compiled from recorded deeds, plats and other public
are hereby not' at the aforeme ' efipubiic primary information sources should be consulted for
need on this map. The es no legal responsibility for the information contained on this map.The
effective date is: June 1, 2006

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Label/Receipt Number: 7005 0390 0000 2809 4597
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• Delivered, July 17, 2006, 3:50 pm, SHALLOTTE, NC 28459 Enter Label/Receipt Number.
• Notice Left, July 14, 2006, 12:17 pm, SHALLOTTE, NC 28470
• Acceptance, July 13, 2006, 1:57 pm, SHALLOTTE, NC 28470
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City,State,MPH .Ls• If / 66^/4 JiC Zcv.`f 7U
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