42832D - HIckman

lirLAMA/ C34EIREDGE & FILL - "
;ENERAL PERMIT Previous permit#
'New Modification -,Complete Reissue r Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources r� �/ /�
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC //7. //O L�,�
ures attached.
:Name Gt N{ !)/C!mi^I Project Location: County v /(N,11 i,/iG k
Z.S o 5412{ L, .e Pit.. C095,L Street Address/State Road/Lot#(s) 2,j V SI 04 t
►"IT#4 8,A C 4 State/y[ ZIP 1.-7,1/L f .DR . /'¢rii
( ) Fax#( ) Subdivision n -
ed Agent ec,i,ii a "WI r- City 544Se1 6 fMc .4 ZIP 2-
CW itiorcf PoPTA [U!S ❑PTS Phone# ( ) / River Basin 4J®
OE ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body L,/a1IE� c4•e'C 1 a /,
PWS: ❑FC: Ili
Maj.Wtr. Body �f
yes / no PNA f i Crit.Hab. yes / no /� Co /
f Project/Activity /e h/ Pk 11 41 04 4 to,'4' j i T' (- 4J1,9-L we 7114.4)
91 ALfiL3) (Scale:/
ck)length - /,p �/ �.. ..__ [
1
c...f
i(s)
�ier(s) --
nth T
ember �,
.iprap length /6 Q ' _ _ C_
g distance offshore 2 I `. '
ax distance offshore 3 ‘.....i fry
hannel
ibic yards / y)/e/ d
mp tt�
use/Boatlift .%,``.. .4 P �' I 's
�\
3ulldozing uY.r
E t _ i
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ne Length / G 0
not sure yes r1_1 r igs: not sure yes ® © , 1111: -,
>Hum: n/a yes . ._-� liffr
--. ;-
ano
•Attached: no 0 i A. ' `,/X
ling permit may be required by: „Sy Arse,` B/A L 4 1 I See note on back regarding River Basin

RONNIE WAYNE MINTZ 66-7143/2531 10 2 5 ' ,
•
DBA MINTZ CONSTRUCTION soo1oo3307
4739 FOUR SEASONS WAY C� -C
ASH, NC 28420 �~ DATE ` '1
FADER THE /�///'C J r(y/ // $/0 1,1e,
ORDER OF r/ � '�/t/ ,p,
€ — e . DOLLARS E ':—
SECURITY _ +
o SAV NGS BANK
Sunset Beach,NC 28470 ( J �„
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I. C53L ? L 1: ��� t
430 . ZOO LO25 ,

---- ,,i 0 92 7 i 2 f
DIVISION OF COASTAL MANAGEMENT
ON/WAIVER FORM
AI LJACENT RIPARIAN PROPERTY OWNER
.e o1 Individual Applying
'v'dual A l 'ng For Permit: C 1\) JC��/►� 1�
ress of Property: 2 SC) s�/D/2.6f //✓- &S T
(Lot or Street#, Street or Road)
SUN$ r / 1 x, cH .AL al- egi
• (City and County)
:rel V certify that I own property adjacent to the above-referenced property. The individual
l
)lyir g for this permit has described to me as shown on the attached drawing the developmen
y
proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
yoi. have objections to what is being proposed, please write the Division of• Coastal
anrgement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39Q0
ithi i 10 days of receipt of this notice. No response is considered the same as no objection if .
)u F ave been notified by Certified Mail.
WAIVER SECTION •
unc.erstand that a pier, dock, mooring.pilings, breakwater, boat house or boat lift must be set
ck;i minimum distance of 15' from my area of riparian access - unless waived by me. (If you
,isb 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.
r_ 2_ c: 6
Date
Sig (Narne
I

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DNISION OF COASTALO AT NOTIFICATION/WAIVER FORM
AlNT
JJACENT RIPARIAN PROPERTY OWNERlvTIFIC
ne of Individu
al A 1 ing For Perm
dress of Property: Z co S H0.4 F L I IJ L
(Lot or Street#, Street or Road)
A S&TJ3&cJ J(,C . a�8 yl ( zio\s10)
(City and County)
ere: certify that I own property adjacent to the above-referenced property. The individual
plyir Q for this permit has described to me as shown on the attached drawing the development they
prc posing. A description or drawing, with dimensions, should be provided with this 1e te'.
I have no objections to this proposal.
•
i yow. have objections to what is being proposed; please write the Division of Coastal
Ianr gement, 127 Cardinal Drive Extension, Wilmington, NC 23405 or call 910-395-3900
vithi. i 10 days of receipt of this notice. No response is considered the same as no objection if
'nu fi ave been notified by Certified Mail.
WAIVER SECTION
I um erstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must he Ge.
bck;i minimum distance of 15' from my area of riparian access - unless
l s waived by me. (If yok
Ns1sb to waive the set el:, you must initial the appropriate blankbelow.)
I do wish to waive the 15. setback requirement.
I do not wish to waive the 15. setback requirement.
Cis�, rune ---- _ Date

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