41548D - Generation

AMA/ DREDGE & FILL N? 4
iENERAL PERMIT Previous permit#
Kew Modification Complete Reissue Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
,oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ,/.7 C)v
kafes attached.
:Name an-v„P,ei --6vA, &&ti 5 . _ —._ Project Location: County gCAAn/514iuc.
3 7 1 �• ��� Street Address/State Road/Lot#(s) <6 1 9
9-Y ,gait State tie ZIP 73/u L411te:tibuay 51
( ) �Y 3--��s'(Jax#(33`) 6 YV ()/a c Subdivision ,/
:d Agent Y m City OCZTAry , /to &&4t+6' ZIP a 6
�CVb O,ew PTA n ES ❑PTS Phone# ( ) River Basin L tier,
❑OEA ❑HHF IH UBA ❑N/A Adj.Wtr. Body C.4141 Ark/w (nat
❑ PWS: ❑FC:
(es / (6) PNA yes / ce) Crit.Hab. yes / no
Closest Maj.Wtr. Body /{.PtAiL✓
Project/Activity f i[14(0 /' r°R F7afefrfi Ai& Doc
/ �!'o (Scale:
k)length
:s) �'l(.3
:r(s) � "
igth �, C ✓f# L
fiber
/Riprap length
distance offshore
distance offshore
innel
.;;-U
is yards
p 70
e/Boatlift_ —
Ildozing I
I �(J r
,
Length _ _
not sure yes no L G yr, 441
not sure yes no ,Z,
Jm: n/a yes
yes o
reached: yes n
g permit may be required by: DC FArI. Z ' -00 -&110 i See note on back regarding River Basin ru

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 1'///larV a2-).
/ 5
Address of Property: /�:7- 91 I izJ2u S77�e r
(Lot or Street #, Street or Road) J
/ Efavri\4 a fr4:
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lette
1Z�� I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coo
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 objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
set bck a minimum distance of 15' from my area of riparian access - unless waived by me.
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.
9 _
>ign Name Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: -4 '11�
(Lot or Street #, Street or Road)
—7 /( I ski/ c
(City and County)
I hereby certify that I own property adjacent to the above-referenced_property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lette
,fy I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Cos
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 objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
set bck a minimum distance of 15' from my area of riparian access - unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
(/-2-,,,,/
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
e 7
iign Name Date
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