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sE N E RAL PERMIT_ Previous permit#
Jew -.Modification Complete Reissue __Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
2oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC )1 I k` 3
Rules attached.
it Name 5ta— T 56Q- Project Location: County Ok)1_,..0 ►•.!
P 0 ►"3.�X 7 J la Street Address/State Road/Lot#(s)
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:ed Agent .^
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CW )Ew TA ;DES ❑PTS Phone# (2 tz) Z F t — 61 River Basin\ )t T4
❑OEA ❑HHF ❑IH =UBA ❑N/A / ST�r--P
❑ PWS: ❑FC: Adj.Wtr. Body f'3 i)44,'n ,5�/�,,,,o (nat.Ij
no PNA no Crit. Hab. yes / no Closest Maj.Wtr. Body ir"1-1-�✓ N/
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IExyzszog op cosTAL WANAWairia
1DJACIO RIPARIAN PROPIRTX MUIR I QVEFICATIONLM FORM
Name Of Indivi l Applying For Permit: /j7/ 7--/VV-frk;729/-1Na
Address Of Frope y: /'2 o�I C�� -r
pv.j) Wi_jz c. a eve o
(Lot or Street #, Street or Road, City & County)
I hereby certif' that I own property adjacent to the above-
referenced grope ty. The individual applying for this permit haE
described to me a shown on the attached drawing the development
they are proposi g. A description or drawing, with dimensions,
should be provid d with this letter.
/J I hale no objections to this proposal .
i
If you hive obie4ione to what is beina _proposed- plane write th
Division of tal Manaaement- 127 Carding Drive Extension
Wialitington. 119 gtolii . 21405 or call 910 395-3900 within 1
mays_ of j eceigt this noj i.ce. _No response is considered the saq
as ppoblActit t f ovou have been notified by Certified Mail
WAIUUER 8$CTIOt$
I understand that a pier, dock, mooring pilings, breakwater, boa
house, lift or eslndbags must be set back a minimum distance of 1=
from my area of riparian access unless waived by me. (If you wit
to waive the s-,tback, you must initial the appropriate blar
below. )
' I do wish to waive the 15`setback requirement.
I do not wish to waive the 15' setback requirement .
-,id _ 4 on.A,;•06-- .
04 mat 1 I II ,r. Da �rik

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