45922D - Jones

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yCAMA/ - DREDGE & FILL
3ENERAL PERMIT
Previous permit#
New JModification LIComplete Reissue EPartial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ) 4i - )Z�
I$Rules attached.
it Name 0\I.C.. A t_ -S o ^E S Project Location: County�e IN) L vim'
i O5. U 51-E A N Street Address/State Road/Lot#(s)
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MICHAEL L.JONES 08628o8368139 14 3 5
MERLE N.JONES 7-z5-0
105 UMSTEAD DR. DATE
CLAYTON,NC' D 27520
PAY TOV S ti��
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THE ORDD""
State Employees' Credit Union®
Raleigh,North Carolina
163
MEMO 7 z.c. 4 (,
I: 2531770491:086288368890 143
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to M I CI-{A EL 1--e (J 0 N E5 's
(Name of Property Owner)
property located at I -0T 23 — (3LOCK A - 793 CHA.D\ /1CJ aHbgE3.D,
(Lot,Block,Road, etc.)
on ft.DW1 ,inSNEDS PERRY — ONSLO \A/ ,N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below,the development he is proposing at that location,
and,I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/bothouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
"�2' �o''IL
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r30AT NTV IL
i NC
/tit.77 I I
L D 7 �o i LO7 83 I LD 41--
1
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to M/ CI EL L_, v 0 N E3 's
, (Name of Property Owner)
property located at LOT 23 — I3LOC,K A — 793 CHADW/G:,5Hbg3,D,
(Lot,Block,Road, etc.)
on C I R-DW 1 ,inSNEf}D5 PER ' — ONs1_O W ,N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below,the development he is proposing at that location,
and,I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/bothouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�2' io�'I ;GI-- /6•77 d—
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WIN
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i NC /fed.7J
L a 7 'a i L or �?.3 1 p T S7(71--
Signa •

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete gna re
item 4 if Restricted Delivery is desired. � El Agent
• Print your name and address on the reverse (�L Aledressee
so that we can return the card to you. B. eceived by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,
or on the front if space permits. r`t / L'� �y��'6
D. Is delivery address different from item 1? ❑ Yes
1. Article Addressed to: If YES,enter delivery address below: F No
/QAI Tf7`6N ' E.
/87go,c-v// //e;yb A u'
3. �SSer��vice Type
`7""� /y +/ /�y Ef ertified Mail 0 Express Mail
/ �~Jc./N9/ _- Y f 22 /2- ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number(Transfer7005 3110 0000 8829 0646
from service lab
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540