42826D - Kelso

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AMA/ Hi DREDGE & FILL V IA a !
3ENERAL PERMIT Previous permit#
1w ._ Modification Complete Reissue Partial Reissue Date previous permit issued
Irized by the State of North Carolina, Department of Environment and Natural Resources 71171.
I �/DCoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑Rules attached.
it Name 42 et- /77/LS. 5I4#1 k"pi j p Project Location: County die w , i Ai#GIC
2 ' 7z m/'R,ii✓P4.1 i-i�¢y 5 Street Address/State Road/Lot#(s) 4 f, y/
iv di T.l,�i4L1 State A/C ZIP Zly6/ 2b2Z/- n t/re,c1 A 5e-
6( /) Fax#( ) Subdivision Si 5,9 m 04 i9'/At1,.,
:ed Agent �`G LU J<'L 19Js City S0'4471 2f ZIP 27y
❑CW Ne$9 IwTA C_ES ❑PTS Phone# ( ) • River Basin 4 m r
❑OEA ❑HHF ❑IH UBA ❑N/A Adj.Wtr. Body I, li✓ Al at /
❑PWS: ❑FC:
yes o PNA yes / no Crit.Nab. yes / no Closest Maj.Wtr. Body /14141
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ng permit may be required by:_2.H,✓5 In/I C J C U , P See note on back regarding River Basin r'
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JOHN M. KELSO 15-7441-2540 2136
l LYDIA W. KELSO
t,F f�� ) [phone] 29975217
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�` 2672 MARINER'S WAY SE. Date
SOUTHPORT, NC 28461 J ��
Pay to the 71C . 1 is /a ,a )
order of �/ t�j 1 l/
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JUSTICE FEDERAL CREDIT UNION
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For —
I: 2 540 744 1 3gLLOOL41368 7 02L36

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: `J G� iy/6-`s 0
Address of Property: 1, 7, aa,z 7 , e SE 1/
(Lot or Street #, Street or Road)
5/,,, x i 3c, -e gL-7--
(City and County]
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tt
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 Coasi
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-391
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 I
;et bck a minimum distance of 15'from my area of riparian access-unless waived by me. (
Tou wish to waive the setback,you must initial the appropriate blank below.)
e"9 I do wish to waive the 15' setbac
k requirement.
I do not wish to waive the 15' setback requirement.
( • YAS---
ign Name ate
4-p-(0,-zp F ( 1 -- -f-E---
int Name _ �!'

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: .Y© h n Kelso -
Address of Property: G& 7Z fl/i ck, -rt ers 5 v-r
(Lot or Street#, Street or Road) /
PUIZ l A/C—
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
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 Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objectioi
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
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.
k°, et4t-Ae_ Sc"?‘ ti—dsa-as—
Sign Name Date
D.