39783D - Amos

ICAMA/ J DREDGE & FILL
iENERAL PERMIT Previous permit#
New Modification iComplete Reissue —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 5A NCAC 7 . /Ze
/ El Rules attached.
Name y/s-7 A/ L7 - /117o5 Project Location: County 4/1 `1' ni41"
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ed Agent / City 4/.// �Ni1y *-2 ZIP 2 g'
Vcw l4 [flTA ❑PTS Phone# ( ) 5 4,..t e River Basin
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❑PWS: ❑FC: � / /� (nat /r
no PNA / no Olt.Hab. yes / no Closest Maj.Wtr. Body //2 ell-9 C 77 e.t/e
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ing permit may be required by: /V ' (/. - . (�See note on back regarding River Basin r
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
lame of Individual Applying For Permit:
address of Property:
(Lot or Street#, Street or Road)
(City and County)
hereby certify- that I own proper adjacent to the above-referenced property. The individua
Lpplyir_g for this permit has described to me as shown on the ar:ached drawing the development the:
ire proposing. A description or drawing, with dimensions, should be provided with this leter.
I have no objections to this proposal.
[f you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 2S40f cr call 910-395-390(
xithin 10 days of receipt of this notice. No response is considered the same as no objection i
ou have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakn;.ater, boat house or boat lift must be se
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifyoi
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15. se:back requirement.
I do not wish to waive the 15' setback requirement.
'it/ 9 9
Sian Name te
1/V1m i, I/11 .

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: I '`' ' /`
Address of Property:
(Lot or Street#, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development t
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 Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 2S'.05 cr call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings,breakwater, boat house or boat lift must b
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
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.
Sinn Name Date
w%.% ,.o as S.-seon-- 1 —"A- :
Print Dame • �►

LYNN G.AMOS 4817
ELIZABETH J.AMOS
210 Hickory Knoll Rd 910-395-4654 ss Zvs�o
Wilmington,NC 28409-4511 ( CH77664
�! Date
Ordere//�i
ofOL/Y � $/O,J, U v
- Dollars e""
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wachovi
Wachoviaa.com Bank,N.A. elP3911.
For 1,,On4.L^i.Ct.E- 'i?-4-}14. M'
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