45918D - Parker

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E(CAMA/ 1A5REDGE & FILL ,
GENERAL PERMIT Previous permit#
w MModification EComplete Reissue CPartial Reissue Date previous permit issued
,rized by the State of North Carolina,Department of Environment and Natural Resources '/
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 71 , 1)Oa
1114kotes attached.
It Name�'! /r)eS ?t AQke2 Project Location: County 234c„✓J41/C4
3o. PA5 Q 5 A• Street Address/State Road/Lot#(s) /3'5 2
l i Pil,el Pam/ State//C ZIP Z 1311)
ci P/l)),fre/2„ —7?2, Fax#( ) Subdivision zed Agent 2, /10/800,✓ City/4i Q// , g 69c. 4 ziP2 f y/
i ❑cw EafW IA--- tE5-- ❑PTS Phone#
( ) River Basin Lim
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body CO,✓AL (> 62/iliAl (nat
❑PWS: ❑FC: d
V 411
yes 7 PNA yes 2. Crit. Hab. yes / no Closest Maj.Wtr. Body / A
If Project/Activity 0 e PQ Z.19C e CSC i S7i,-y 1 c.r G-��J1e ct'
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not sure yes no
;s: not sure yes no - -
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Attached: yes no f . 31.04.
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WILDLIFE PORTRAITS.WE

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curHL MIN i turAKIAN FKUYlK 1 Y U WNER NO 1-1tICATION/WANE{ FORM
1
of Individual Applying For Permit: - �' ;' } r
ss of Property: F
(Lot or Street#, Street or Road)
(City and County)
by certify that I own property adjacent to the above-referenced. ro e
P P rty The individual
ng for this permit has described to me as shown on the attached drawing the development they
)posing_ A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
have objections to what is being proposed, please write the Division of Coastal
gement,.127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
110 days of receipt of this notice. No response is considered the same as no objection if
ave been notified by Certified MaiL
WAIVER SECI`ION
erstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
k a minimum distance of 15' from my area of riparian-access-unless waived by me. (If
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
l , - _
lame
Date
rjI i

•
.�LJ Ht_r tN t tur JwuN IKUYt:K 1 Y OWNER NOTIFICATION/WAIVER FORM
ie of Individual Applying For Permit: / i i qi, Ve ,n
ress of Property: Q ,� O t �
(Lot or Street #, Str�et or Road)
(City and County)
�eby certify that I own property adjacent to the above-referenced_property. The individual
ying for this permit has described to me as shown on the attached drawing the development they
)roposing_ A description or drawing, with dimensions, should be provided with this letter.
___J ______
I have no objections to this proposal.
on have objections to what is being proposed, please write the Division of Coastal
iagement,_ 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
tin 10 days of receipt of this notice. No response is considered the same as no objection ii
have been notified by Certified Mail.
WAIVER SECTION _
derstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must b<
)ck a minimum distance of 15' from my area of riparian access -unless waived by me. (1
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 1 S' setback requirement_
/ g
c_ Z-------
1 Name
Date
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