41562D - Crouch

( AMA/ DREDGE & FILLM Q
NEJRAL PERMIT Previous permit#
levP41 dification 'Complete Reissue ' .Partial Reissue Date permit ermit issued
previous
•ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC ig • ZDOO
❑Rules attached.
t Name 1.0e C/7/�//'totf c 4 Project Location: County ,4 ' s- eu��A;
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g permit may be required by: �j^/4/4 y///e IP4"• > See note on back regarding River Basin ru

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION &WAIVER FORM
Nariie of individual for: -12s Lvt j�
��p{ty�rf9-)- - /rr�r�t _
Address of property / lr�nro �J�� t'�rtittentlai 13 w. /j,1(
J
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit 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 of- _
a a no 0 Please initi I below if you h ve blectiona
you.ha a s , ' -Of Y�F.
Nlanageraerr , 1 - arn�at.i `rve Exbensron;VU1rrsngEen, N. C. 213405ititliafi94
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.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must beset back a minimum 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.)
I DO wish to waive the 15' setback requirement.
I DO NOT wish to waive the 15' setback requirement.
Signature & Date
/Li /Q /t � � Print Name

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION &WAIVER FORM
Name of individual applying for permit Liz 64441
Address of property 7/, //Vvre £L �i/dLr6legid1d 13L-m
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit 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 of notificati n.
Please initial below if you have no objections. �'p'11 Rowd., S
115 06 I have no objections to this proposal -5Xlif v4 )Qvv�?.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension,Wilmington, N. C. 28405 or call 91
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.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must beset back a minimum 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.)
I DO wish to waive the 15' setback requirement.
I DO NOT wish to waive the 15' setback requirement.
Z-(//// '
5 -la-Zallh Signature & Date
I /Alh& ?1/r'n c S/A7tfi Print WRrnR

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// DOLLARS
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Centura
RBC Centura Bank
Ii \ R BC Wrightsville Beach,NC 2848 7�
FOR 00 ' N ^1)YA c/ifer 714e
I 0000 3 16 7 20 1:0 S-3 1008 50(:0 27 200 58090
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