40408D - Jeffs

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r±'AMA/ DREDGE & FILL w s .,
3NERAL PERMIT Previous permit#
w 'Modification 'Complete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural R ources // C)
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC t '/ 0
[i '� /'
RuIes attached.
it Name �i "_:7'A S'FF5 Project Location: County M I/et-SL✓IC/C.
L)u rQ ea &4 6. LA-A/C Street Address/State Road/Lot#(s) d'6 y jitkPo 1,
/'( 14;/( State /L ' ZIP .27pq t HA6iN(v- In/yti , ( O 1— /3
6(4'/ ) D// !3 Yj Fax#( ) Subdivision Mr2a' ' C.A t ti.Gr
:ed Agent 61(v t; A/pen. City HU/4r l eAC F/ _ ZIP . 21 V
�CW ®•BW QPTA - ❑PTS Phone# ( ) River Basin L.i1 rill
I
❑OEA ❑HHF E IH ❑UBA ❑N/A Adj.Wtr. Body Ark)LJ te.
❑ PWS: ❑FC:
yes no PNA yes no Crit.Hab. yes / no Closest Maj.Wtr. Body AS�/w
f Project/Activity fig; alt. if;el i�o4/ liff
„
(Scale:
Ick)length /ygi I x(s 1 c.../
n(s) /„,) 'X41 , ,~ O ,.t '' ij 1
D
>ier(s) /y' 01 L b r (/J f/0J,,
!ngth
mber
d/Riprap length _ i
g distance offshore ^' 106
ax distance offshore
hannel
bic yards
lip `i
II
js Boatli, /, n2 ` '�_______.,.__
,ulldozing J
/oar` � ')(i / (
l
�e Length 63 �
not sure yes no
;s: not sure yes n I „i /3
-ium: n/a yes 6" v
yes
4ttached: yes no
ng permit may be required by: /D/Jeti i_Q(// . See note on back regarding River Basin r

r.iv i turAtuAIN rxuFEK 1 Y O W NER NOTIFICATION/WAIVER FORM
ame of Individual Applying For Permit: Q4Y
ddress of Property:
(Lot or Street #, Street or Road) J
Be44C
(City and County)
hereby certify that I own property adjacent to the above-referenced.property. The individua
)plying for this permit has described to me as shown on tl:.e attached drawing the development the'
.e proposing. A descrip ' n or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coasta
[anagement,. 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3901
ithin 10 days of receipt of this notice. No response is considered the same as no objection i
)a have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must b,
t bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I
)u 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.
. „ Date
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From: 8429808 Page: 2/2 Date:4/8/2005 7:2918 PM
L`W.it\k r.iv t K. t.LAl13 t'1cyrt<K 1 Y OWNER. NO t tFli:A,i ION,WAIvER FORM
Mane of Individual Applying For Pcrolit: _ €fk c
Address of Property: • . •
(Lot or Street #, Street or Road)
1�v T // %4 / /".✓4-vwf <a ,.1
(City and County) - -
I hereby certify that I own property adjacent to the above-referenced•property. The individu
applying for this permit has described to me as shown on tL a attached drawing the development the
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 Coast.
Management,. 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39C
within 10 days of receipt of this notice- No response is considered the same as no objection
you have been notified by Certified Mail.
WAIWR SSCTR N —'
I understand that a pier, dock, mooring pilings,breakwater, boat house or boat lift must t
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 IS' setback requirement.
I dg pot wish to'waive the 15' setback requirement.
Sign Name Date
i �� n. ,. ,of.. AYw

r^A luonsguzis Grayson-Research
8429808 Page: 1/2 Date:402005 7:29-35 PM
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