41474D - Lewis

rAAINIA/ --DREDGE & FILL N9 4
3ENERAL PERMIT Previous permit
'{slew Modification Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Reso ces
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC WA/200
f / Aftll
es attached.
:Name 5e/e. t/ Zeta;S / J Project Location: County de-
?Z D 9 je DT7L5 All Coop �a1. Street Address/State Road/Lot#(s)
?'irhitt��h State ZIP 29yll S444e
(1/a)64—/,II Fax#( ) Subdivision
ed Agent City ZIP
Cw .EW 'J$TA 'd'€S ❑PTS Phone# ( ) River Basin_Asti ,
❑OEA ❑HHF _IH ❑TUBA El N/A
Adj.Wtr. Body 17fwW (nat 4
❑ PWS: ❑FC: ,y
yes /�i ) PNA yes /61 Crit.Hab. yes / Closest Maj.Wtr. Body �`C.�°u�"
Project/Activity "✓IIpUSPill 7 - A.... 4' ,1'0/ V' 407111 /0i 7Li6cmi ,
(Scale: 11�
:k)length 9 y ZG
(s) /Q X IZ
011)
er(s) /
,gth BIZ
nber
I/Riprap length
distance offshore it7
x distance offshore X/1
annel
>ic yards ��
--
se/Boatlift
��-(-�
illdozing V
s Length 50 i fi
O,
not sure yes n -
not sure yes no 1 VO' Suth /I///1 `Wc4 It
ium: n/a yes no
yes no
atached: yes /
ig permit may be required by: _ lender Gb der , See note on back regarding River Basin ri

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Jame of Individual Applying For Permit:5'e_ / (.7
address of Property:_2,2� )--71:,/��//%,C/,/1
(Lot or Street #, Street or Road)
/ �J � �-c) ��f� ✓�
(City and CounCy) 1/
hereby certify that I own property adjacent to the above-referenced property. The individua
.pplying for this permit has described to me as shown on the attached drawing the development the
re proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
f you have objections to what is being proposed, please write the Division of Coasts
✓Ianagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
vithin 10 days of receipt of this notice. No response is considered the same as no objection i
'ou have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be s(
)ck a minimum distance of 15' from my area of riparian access- unless waived by me. (If yo
vish 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.
Name Date
/

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: e 4(
Address of Property: 22O115o7 G.)o 77- /d'
(Lot or Street #, Street or Road)
(City and County) ��7/
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 the attached drawing the development th(
are proposing. A description or drawing, with dimensions, should be provided with this letter.
,f' 4y 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 910-395-39(
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
I understand that a pier,dock, mooring pilings, breakwater, boat house or boat lift must be s
bck a minimum distance of 15' from my area of riparian access- unless waived by me. (Ify(
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.
i���o� '' /d MA Zoos
Sign Name Date

PAY TO I I IL
ORDER OF 1� J $ 100 < l/
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cash.
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FIRST CITIZENS 354 ( )
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