42850D - Cymbala

k.CAMA/ -DREDGE & FILL V(j19
3ENERAL PERMIT Previous permit#
New __Modification __ Complete Reissue Partial Reissue Date previous permit issued
>rized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Com Sion in an area of environmental concern pursuant to I 5A NCAC ) ii . 25_ 3O
L .co- 4 O t . FOB (rrk D7Qt,,a, 91Ar,. A. \ulesattached.
ithehme E QZ C GYM 13 I a L n Project Location: County Oro S L Sc.-2
7J LI H a t-L. t, Street Address/State Road/Lot#(s)
bS Fs.O.-a y States.) - ZIP Lag v 2 o- 51-' L'-
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zed Agent bViL e......ywN?,AA_A City SNCAlS RE IL '—, ZIP 28`4L
Cw TA DES ❑PTS Phone# ( ) - River Basin Wy2'(C
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yes Apo PNA ( / no Crit. Hab. yes / no Closest Maj.Wtr. Body IAA vs./v✓
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: ER.,i C c.,1,rn,3 a LF\
Address of Property:_2 0 A _5A E,L.L_ CZ- `►:z
(Lot or Street #, Street or Road)
_ - N E,a, F ..9-Q---( / NI 2uA cea
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individw
applying for this permit has described to me as shown on the attached drawing the development the
are proposing. A description or drawing, with dimensions, should be provided with this letter.
7 I have no objections to this proposal.
1,44)
If you have objections to what is being proposed, please write the Division of Coast:
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must be s,
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yc
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.
is c..,t} 221 . lvh_ 7/v7
Sign Name Date
7A 7k. lr ,A ciii6,/1MAI AAA