37890D - Generation

1JCAMA/ DREDGE & FILL 111 "
iENERAL PERMIT Previous permit#
New -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 15A NCAC —r / `"•v
/ ❑Rules attached.
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•V i I^ing permit may be required by: � '�"-- /S/Y "—A-4.- a ..- �t See note on back regarding River Basin r

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 4eix,471rery.,t /3 , S
Address of Property: )4-4 I
(Lot or Street #, Street or Road)
IrZUk.)Czee.0
(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
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.
L/Lrn
Sign)(Tame Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: evL-7. 76„.? ,fitidAa,
Address of Property: 2-0f 3
(Lot or Street #, Street or Road)
fir Kf&r1e ra
(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
Calif I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
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.
Sign Name Date

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