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CAMA/ ❑t$REDGE & FILL
;ENERAL PERMIT Previous permit#
rNew ❑Modification El Complete Reissue El 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 SA NCAC 2�•J/07
L .Rnies attached.
t Name f/tj9,✓k /7 W 't Project Location: County git!'.✓JL.✓/C. '"
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DIVISION OF COASTAI.11I AN kry.EXTENT
ADLACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit /�.9ei,' M.ar.F!
Address Of Property: /CG �'/�i9�LQ J .5
14;12 ,/ Bf/e /VC ,4-71G 2
(Lot or Street At, Street or Road, City &County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
_I have no objections to this proposal.
If you have nhjentinns to what is being prnp4-Kpri., please write the Division of Coastal
Management 127 North Cardinal Dive; Wilmiti on, North
39f1t7 within If!days of trrr' of Carolina_ 84I;5_or tall 910 395-
tptthis mince No i'cpnnse_ts cnnsidried the same as no nhjertinn
if von have been notified by Certifier! Mail
WAIVER SECTION
I understand that a pier,dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I da_not wish to waive the 15' setback requirement.
Alp7AFA
Signature Date
DIVISION OF co&STAI.11[AN&GEMF T
AD,IArENT RIP kRLAN PROPERTY OWNER_NOWnrAT1ON/WAJ'R FORM
Name Of Individual Applying For Permit 1;)i9A ,(' Me c
Address Of Property: /G)
,61'LbeAl &-4eAt .6:eEiiosatrc�
(Lot or Street#, Street or Road, City&County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to the as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this r /�11 ;;1' '
proposal- � % NV2�-rf %
If you have nhjertinnc to what is hying pmpnrsek please write the nivision of Cnactal
Manaorment 127 North Cam:final Dive Wilmin5on,Notch ramolina; 28405 or call 910 395-
3900 within 10 days of of this notice No
receiptresponse isrnnsidrund the same as no nhjrriioq
if you have been notified by rrrtifierl Mail
WAIVER SECTION
I understand the a pier, dock., mooring pilings, breakwater, boat house, lift or sandbags
be
set back a minimum distance of 15' from myarea of must you
riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
✓.44.4'J I dart wish to waive the 15' setback requirement.
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