41534D - Gosney

'tCAMA / wt$REDGE & FILL `. �
EeN ERAL PERMIT Previous permit# _
w Modification ' 'Complete Reissue Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -)N-/r/( 0
Cl' Ies attached.
:Name )eAmit S &OS,j y _ Project Location: County 3,kiN5I4/(C/<
P` O . 4 315. 1 -_ - Street Address/State Road/Lot#(s) //O/ (bD//Q
✓t t)NCu L State n/C ZIP 2 1 1 j!
(70$ , a 1 -Y001 Fax#( ) Subdivision
ad Agent Gd vi /jn''f Z City StAN5e1 (3M( ZIP .)O6
❑CW CHEW 1 VTA igfS ❑PTS Phone# ( ) River Basin Z.,143N!
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (,/ti4 L Or A/(Aim./ (nat/t
❑PWS: ❑FC: C.
yes / no PNA yes / no Crit. Hab. yes / no Closest Maj.Wtr. Body X/AAA,
Project/Activity 6.t f/K/IQ4-0 'E P/f-1 n..ep4
(Scale: //r
:k)length l '
(s) q 1 Sfr , 0 '''
er(s) 0 A'4 E7 p I)l�
,gth \ii �"6 u Ks N
ttNer
1
114iprap length q,._ '_';*,. _.ate_ o�
distance offshore 2 i 4
c distance offshore 5 1
tA
annel , 1
is yards �.,� ���s fi w"I (1
Ip r
iel Boatlift __
o / bo/p 4 i n. P [._
illdozing
Length 3 /
not sure yes. not sure yes r l
gym: n/a yes
yes n
ttached: yes (no DO//"/1�,'' 4'''
g permit may be required by: 701,vw 0C j L� {F! , b 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: )f G',1/ • . ,, ,U =1 •
Address of Property: C i j j Jh J f
(Lot or Street #, Street or Road)
(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.
If you have objections to what is being proposed, please write the Division of Coasts
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
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
[ understand that a pier,dock, mooring pilings, breakwater, boat house or boat lift must be sI
)ck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yo
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
_X I do not wish to waive the 15' setback requirement.
'7L,2I
;ign Name Date
'rint Name
r:;'
'rr�

A ) Ak -r- E R._
;.j P o 50 g��,i t L E A cL
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• DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: aft,,, 5 g,
Address of Property: 4 O/ obi rA- 5-7
(Lot or Street #, Street or Road)
L.> 5e-/— )J C IA, c telt:
(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.
�- - S-a-Os
gn me Date
/A � n•oo �1 di „ a / AW A

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