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ENERAL PERMIT r Previous permit#
New JModification _Complete Reissue Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources ``tt� /)
Dastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7iT. l . 2
111.4tles attached.
Name CJ rh CIJ/"f.-S ' t Project Location: County , d i 6,
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6A- LP /1 , )D1';/42 4 A Street Address/State Road/Lot#(s)
ri ill idSfe464 State. 1 ZIP 7$V//3 "71
(1/4) Z1Y -i 2Z$Fax#( ) Subdivision_
:d Agent City ZIP
❑CW rya '_`"!T ES ❑PTS Phone# ( ) River Basin (p. ,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body ./r w44.J (nat /g
❑ PWS: ❑FC:
'es PNA yes / Crit.Hab. yes / Closest Maj.Wtr. Body ��0-4 A
Project/Activity / 1;14P� ,d A'A I— L 4il
` (Scale: /Nam-''..
k)length
s)
!r(s)
gth
fiber
Riprap length
distance offshore
distance offshore
trine! _.
is yards
Pam,�``"�
e/t1Q�SLL� !'ZX/Z 0 /0,/� otoOsCA
11dozing Eall 'VA II
Y W *AR UN +./ ` + tr
lb c/'
Length 5-0I EtISii
not sure yes ho *lt
not sure yes /no
im: n/a yes no / „
yes no (�Jl T (i j►
ttached: yes
g permit may be required by: Apt)(V ro See note on back regarding River Basin ru

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: - _)t 5 t
Address of Property: ]tit 6,-1 A�C 6ci ci 9(CF c/—/ZZ(Lot or Street Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced_prope.y. The indivic
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 Cow
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3!
within 10 days of receipt of this notice. No response is considered the same as no objectioi
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
set bck a minimum distance of 15'from my area of riparian access-un 1. ived by me.
you wish to waive the setback, you must initial the.appropriate blank be;: • .
I do wish to waive the 15' setback requirement. 'L C\�
I do not wish to waive the 15' setback requirement.
fi--zt2eti—it) cc--
Sign Name Date

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