41569D - Atkinson

CAMA/ DREDGE & FILL N° 4
;ENERAL PERMIT �7 Previous permit#
New —Modification ❑Complete Reissue Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural esources;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ?N• 1 1 00 ) H. ) Z
Rules attached.
:Name ti iktA L 1c. itillet AT ifs tJ 3 ,....) Project Location: County 0 f.7S t... •✓
I 5t4 A.)(i-L6:70t.J 4 Street Address/State Road/Lot#(s)
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( ) Fax#( ) Subdivision („A-1)\b v•iTG IL Si-la(LE�
edAgent >j\\T. PALi�i-1,5 City'SJf.IA,bS C��IR-y ZIP Z.SWb
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❑ PWS: ❑FC:
yes no PNA no Crit. Hab. yes / no Closest Maj.Wtr. Body 1
Project/Activity ZN t).Lt. IJ1.,✓ Wit,•t..x- Fti=.. 2.) bo(41.-& fL v ACl_';> 'r ;eJY
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igth ;
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1 attached: yes no I
ig permit may be required by: Ok15 L.,OyJ LOLA{v j y . See note on back regarding River Basin ri

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3 mid N❑13-19NIS 0000000000 ZE:6I 500Z/92

25/2005 19:32 0000000000 SINGLETUH PAGE
DIYMIMPFciclittlIALLIMSACHWST
AINACESZKIVIEWIrpanairomausonpiCAUCINZEM
Name of Individual 4ppiyin Pm Permit_��_ . 1 j1l,6 ►•? _
address f Property:L.2.6 .,2 19
(Lot cr Street#,Street or koad)
l
rity and cow)
I hereby certify that I own properly a4jacent to the above-referenced property. The individual
applying for this perm t has lcaontd to me ca 813trntd Cr the attached drawing the development they
are proposing. A Or drawing, with dimensions,should he provided with this letter.
y X have no objections to this proposal.
If you have objeetidos to what is being proposal, please writs the Division of Coastal
Management, 127 Cfirdinal Drive Extension, Wtllnlagten, NC 2S405 or call 910-395.39OO
within is day,of receipt of tbi.note. No response is considered the same se no objection if
you have been notillar by Cart led Mall.
-
I andentabd that a pier,dock,mooring pilings,brea►iovater, boat novae or boat Lift must be
set Lick R rnleiMam dries of 15'from my area of riparian access-mitts waived by me. (if
you to-wove-di e etbacic,you most initial the appropriate blank below,)
I do wish to waive the 15' setback reguiremett.
do not wash to waive the 15' setback requirement.
Sign Narne Daft
Print Name
�$ 02. o NC
D
'Telephone Numbot with Area Code

l
D.W.SION OF QQA�1' L JANAGEMENT
D.IACEN'I'RIPARIAN PR )PF.R TY OWNER NOT ON/WAIVER FORM
Name of Individual t.pplying For Permit: U
Address of Property: I�� c. dl/
Lot or Street#, Street or Road)
5N'cO5 rrrri Aj
(City and County)
I hereby certify that own property adjacent to the above-referenced property. The individual
applying for this perm.t has described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions, should be provided with this letter.
T I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
RIVER SECT
I
I understand that a pier, dock, mooring pilings, breakwater,boat house or boat lift must be
set bek 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.)
1>. --
I cio wish to waive the 15' setback requirement.
—
I cto not wish to waive the 15' setback requirement.
_7:Ti:7: - . ..71W 5 65
Sign Name Date
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Print NamATA
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• x Pay to the Vn I� n �b
Order of ' �� `l`— C�=� I pZ�
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Dollars � wm Me..
CHUC INSONL
FIRST CITIZENS 451
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BANK Firsl C tizans Benk d Trusl Company /,'\ 1/� ,, :"
Enasd�Forry N.C. ET,m liL(S 6 9 �,�+` N \ \'/\ 1\.`)'
^M Nrvvy�fl�s citizens oT«(� �..! l `
For af�' /) ) ` S � ,�;• �': •
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