44931D - Story

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ICAMA/ DREDGE & FILL `I '
3ENERAL PERMIT Previous permit#
rlew _Modification Complete Reissue Partial Reissue Date previous permit issued
prized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ) ' - \Zn
t$Rules attached.
it Name , E- 2`\ -"1- 2y Project Location: County A:: tJ C'L
1 1 3 ►?j‘...i-N D --1.-ic ( A.‘V.,t Street Address/State Road/Lot#(s)
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t(qL Z)3 Zs ` ic3%5' Fax# ( ) Subdivision
ted Agent City ,jam'-f ( -'LD ZIP 2,8`I I.
❑CW W V PTA _ES ❑PTS Phone# ( ) River Basin Cap'G
❑OEA ❑HHF IH UBA J N/A
Adj.Wtr. Body &NOV—__S G+-1+'\1.)0-- y6. (na /
❑PWS: ❑FC:
yes / J PNA yes /0 Crit.Hab. yes / no Closest Maj.Wtr. Body 5 A 4— )J�" i
f Project/Activity L ''5—'�1.-1. G X i to F t_ caT e (2. +L 1 Z.X 1 Z G.L...
(Scale: I % 2
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imber If., t
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g distance offshore
ax distance offshore
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hannel N,
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mp _
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ie Length 51;)
not sure yes no
gs: not sure yes �° `rium: n/a yes ® L. P
4.
yes
Attached: )(9 no
'ping permit may be required by: v`tL'F (/21f \-1 . -__See note on back regarding River Basin I

ROBERT T. STORY OR
ROXADA H. STORY L. 2 3 91
6619 HUNTERS LANE PH. 919-544.2017 �.
DURHAM, N.C. 27713
PAY TO THE � C I 2531
ORDER OF C
CLEARS
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PO.BO 9.RALEIG NC 658 '?
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: R0154614- i2c)y kcIA. 57-c/Z
Address of Property: 113 gt.4,0 b 7-- #2 12A C.r
(Lot or Street#, Street or Road)
5 v QL F G+y PFbn o w-t-7 ,%.
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
arc proposing. A description or drawing, with dimensions, should be provided with this lettc
I have no objections to this proposal.
P P
If you have objections to what is being proposed, please write the Division of Col
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910--I9(
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu:
set bck a minimum distance of 15' from my area of riparian access- unless waived by me
you wish to waive the setback, you must initial the appropriate blank below.)
AI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
3- /5--Ob
Si n N m Date
_ in tnw . IPT.P►r1Jic ,��TA

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: i 2c�ID C VZ-f PA CIA- cJ rc:
Address of Property: / 13 /3 6 A-' 6 T� i4 r zvis
(Lot or Street #, Street or Road)
cOI y 6 Co./
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indi
applying for this permit has described to me as shown on the attached drawing the developmei
arc proposing. A description or drawing, with dimensions, should be provided with this let
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of CI
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-77qi
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift nit
set bck a minimum distance of 15' from my area of riparian access- unless waived by to
you 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.
4044A, • M N-OC
Sign Name Date
(A) <<114 r. n/16 ,. A. A