43956D - Piepmeyer

'CAMA/ '/DREDGE & FILL Yr?--,
3ENERAL PERMIT Previous permit#
vNew Modification Complete Reissue 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 15A NCAC ) \. \, e.
XRules attached.
it Name 1 v1" c)1. r. { •is `) r It_ Project Location: County Pt , p is (L,
1 2-2-- ,� rA b v Z t; ri• 'b,2 Street Address/State Road/Lot#(s)
At, �s I C k b State L)6 ZIP 2.:3 y `1 1 ZZ— 3 9...fl4 i>v'L v., b!L
`( ) Fax#( ) Subdivision
:ed Agent 'tiV<<-�L c.11 • ? 1 iv City A- 1 t1A13 ZIP 2.8 N
cw tW I TA JS E PTS Phone# ( ) River Basin�;{D C
OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body A Lt,`'l (nat /
PWS: ❑FC:
yes /� PNA yes /� Crit. Hab. yes / no Closest Maj.Wtr. Body ���-��
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ng permit may be required by: PC N�L n. V.) . See note on back regarding River Basin r

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: A✓I Aia•76-ye----
Address of Property: /Z Z d,-04d�/1 4.1
(Lot or Street#, Street or Road)
//4/..A ra":46 /VC z_FWJ
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individu2
applying for this permit has described to me as shown on the attached drawing the development the
are proposing. A description 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 Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721
within 10 days of receipt of this notice. No response is considered the same as no objection
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 sE
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yo
wish 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.
Sign Name Date
/¢7if/274 /,6//s AVA

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.S. Postal Servicen., U.S. Postal ServiceTM
ERTIFIED MAIL,., RECEIPT l . u CERTIFIED MAIL., RECEIPT
Domestic Mail Only;No Insurance Coverage Provided) t.t (Domestic Mail Only;No Insurance Coverage Provided)
or delivery information visit our website at www.usps.comp For delivery information visit our website at www.usps.com,
' e'sFDR Ise I A L USE
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Postage $ iiii:a5 Postage $ iv.o:,
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LI-44: ; I] Certified Fee i-t-i
Certified Fee i l0 02 Postmark
J Postmark
Return Receipt Fee sJ.l..oiv Here f=1 (EndorsementRturn Receipt Re e Fee
i'-'•'3'i Here
r dorsement Required)
testrlded Delivery Fee ! CI
Restricted Delivery Fee i,j•i i6
ery `- .a '� (Endorsement Required)
ndorsemeM Required) i rl
,�,,, m F3.ij�, 01/27i 2006
Total Postage 8 Fees $ s it.4 ' ik Z4i;VA Total Postage&Fees
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// // � Sent To
ern To 114
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S Form 3800,June 2002
See Reverse for Instructions PS Form 3800,June 2002 See Reverse for Instal
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
A Sfg re
• Complete items a 2,and 3.Alsod complete aiL Zile"item 4'rf Restricted Delivery Is desired. �' ■ Print your name and address on the reverse XC. Date of AddDelressee
so that we can return the card to you. B. Received by(Printed Name) /.
• Attach this card to the back of the mailpiece, l/ /l/i�L, / c, 7 —.),c,_O
or on the front If space permits. D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: tf YES,enter delivery address below: 0 No
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O S /()/g/,�1)(10O 5 t 3. Service Type
O / ❑Certified Mail ❑Express Mail
LLJ6u �Q�/ A/C ❑ Registered ❑Return Receipt for Merchandise
J ? / 7 C O Insured Mail C.O.D. t.
b T C� J 4. Restricted Delivery?(Extra Fee) 0 Yes
6184 9617
2. Article Number - - 311a ,
(Transfer from service Iaee+) 7 � - 7�tJ 5
rilestic Return Receipt 102595-02-M-t540
PS Form 3811,February 20 d