42362D - Mitchell

CAMA/ -DREDGE & FILL v L1 N? 4
IEN E RAL PERMIT Previous permit#
New Modification i 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 I 5A NCAC ' ,Z•D-D
'Rules attached.
Name SS.��^, � Y L a L 5 1-.4... Pa, Project Location: County L I
S'3 1` ,Z t L -ski,N t.>it.... Street Address/State Road/Lot#(s)
:=JSIS3L StatetJ ( ZIP 27)96) 01°1'e) 6?A1 � 5 i
( S(.)r'ltab -Ol-ly +yFax# ( ) Subdivision
:dAgent Ci�PgNIL- 13?A<tit ZIP Z c"' t'j Al
❑CW >kWCPTA E ES ❑PTS Phone# ( ) River Basin CA P t
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g permit may be required by: 1 c'3 Ar1L 1�r A L . 7 See note on back regarding River Basin ru

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
•
game of Individual Applying For Permit: / fZ . 47/ iC 11° 11
Address of Property: q 9 Gaye
(Lot or Street€, Street or Road)
To fl5 11e1,e-y /V , ti "B 1�e/i-
(City and County)
I hereby certify that I own proper- adjacent to the above-referenced property-. The individual
applying for this permit has.described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions; should be provided with this lever.
I have no objections to this proposal.
If you have objections to what is being proposed, please Write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, i\C 2S-05 cr call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION •
I understand that a pier, dock, mooring pilings, breakwy ater, boat house or boat lift must be set
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
Dw 1 l I do wish to waive the 15 setback requirement.
I do not wish to waive the 1.' setback requirement.
Sicn Name Date
fkIP ,r ..

DIVISION OF COASTAL MANAGEMENT , rr,..r
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WA.IVER FORM
Name of Individual Applying For Permit: y./1N�,Y G', l`7 IC'l(
Address of Property: arY to i rre t
(Lot or Street€, Street or Road)
749,4v. ^( /99iec4 47 G, } j-?ndo-✓- 40'vz y
(City and County) l
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions; should be provided with this letter.
4 I have no objections to this proposal.
If you have objections to what is being. proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension. Wilmington, NC 2S405 cr call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION •
I understand that a pier, dock, mooring.pilings, break-water, boat house or boat lift must be set
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
_____)(6a2e(\
I do v_i_lb.to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,% n
Sign Name Date

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