404060D - McCoy

CAMA/ 'DREDGE & FILL N? 4
;ENERAL PE RMIT Z./. Previous permit#
New Modification Complete Reissue - Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources �l
;oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7 h, I Z Q P
j Lf'Ru es attached.
Name Rb M Lik ! e�0 V Project Location: County rPkt iP
/430 Ft. city y /'i`, /4-I P Street Address/State Road/Lot#(s)
/l wip51 °a 4 State,VC ZIP Niiit3 -,4 m t
( 'lO ) AG IVO Fax#( ) Subdivision
ed Agent City _ ZIP
❑CW [SEW "PTA -'ES ❑PTS Phone# ( _) `" River Basin
❑OEA ❑HHF ❑_IH C UBA ❑N/A Adj.Wtr. Body /¢/Gk!/ (nat
cAl
❑ PWS: ❑FC:
Kes /(5 ' PNA yes /6) Crit.Hab. yes / o Closest Maj.Wtr. Body
Project/Activity 40 $5PJ h r )1�+' f -t 'd 1tl p�,
r (Scale: )//?�,
:k)length _
(s) /D X Z 0 (pro ix A I u)
er(s) L
igth 0 O
nber tat /1e y to'
I/Riprap length t '
distance offshore
(distance offshore 0 ©/
annel 4..3)4
is yards
P ,y 1Y V
3Ti3xi3 Y
illdozing �/ t�y y Pier
Length /
not sure yes — ,.. __r___
: not sure yes
um: n/a yes Lb+ i41 D
yes
ttached: yes
ig permit may be required by: / h4("Q . See note on back regarding River Basin ru

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/40-7 -I A;'W I D
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: gDJ'Y im VS )71%
Address of Property: l/�� 1=f�C 7G7j/y ?. TR, 1' —)O
(Lot or Street#, Street or Road)
Hi9mP5 .7/q 0 I1, Lz RY '13
(City and County)
I hereby certify that I own property adjacent to the above-referenced_property. The individi
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.
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 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
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.
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Sign Name I Date
AMA

DATE / , LJ/ V J
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TO � //
a � ORDER OF $ Z60
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FIRST CITIZENS 365
BANKFira-gier .Benk 8 hW Company
Hampstead,N.C.28M3
� www.firstcltizens.com
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