38560D - Mohr

ICAMA/ Ti DREDGE& FILL
3ENERAL PERMIT / Previous permit#
iNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina,Department of Environment and Natural Resources '!
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -7 12 6
❑Rules attached.
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tS FOX HOMES,LTD /
Town of OIB. 10/13/2004
Type Reference Original Amt. Balance Due Discount Pa)
3/2004 Bill • 1 Pender 100.00 100.00 11
Check Amount 11
A c/(-1 e'/Q
stal Federal-Checking 1
mat-otnaot PR00094 Reorder from BEST CHECKS,100 Executive Dr.,Unit 1,Dulles,VA 20166•Phone:[phone]•wtw.MstcMcka.c s

OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
items 1,2,and 3.Also complete A. Signature �U/I
estricted Delivery is desired. C��� ❑Agent ealr-V
name and address on the reverse X -41s 0 Addressee <-'
can return the card to you. B. Received by(Print Name) C. Date of De'very
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eased to: If YES,enter delivery address below: 0 No
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4. Restricted Delivery?(Extra Fee) 0 Yes
Der m service. 7002 0860 0005 3217 1842
1,August 2001 Domestic Return Receipt 102595-02-M-1540
•MPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
terns 1,2,and 3.Also complete A. '.na air
stricted Delivery is desired. // — : •gent
-lame and address on the reverse X/ y' �- �` �. ■ Addressee
can return the card to you. B. Received by(Printed Name) C. Da•of Delivery
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ront if space permits.
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ter 7002 0860 0005 3217 1835
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1,August 2001 Domestic Return Receipt 102595-01-M-2509

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CHARLES FOX
HOMES
Certified—Return Receipt Requested
October 12,2004
Peter&Juanita Fickling
3056 Sides Drive
Connelly Spring,NC 28612
RE: CAMA Permit Notification
Dear Mr. &Mrs. Fickling:
This letter is to inform you that I have applied for a CAMA Permit on the property located at
Lot 25, Canal 6, Section A & B, 1 Pender Street, Ocean Isle Beach, North Carolina. CAMA
regulations require me to notify you of my intentions. I have enclosed a copy of my permit
application and a copy of the drawing of my proposed project.
If you have any comments on the proposed project,please contact Justin Whiteside, local CAMA
LPO for Ocean Isle Beach at 910-579-3469.
Sincerely,
4444
Charles W. Fox,III
Charles Fox Homes,Ltd.

jteoo°°..""n'ssihhi
CHARLES FOX
HOMES
Certified—Return Receipt Requested
October 12,2004
Frank B. &Peggy R. Dean
PO Box 725
Laurinburg,NC 28353
RE: CAMA Permit Notification
Dear Mr. & Mrs. Dean:
This letter is to inform you that I have applied for a CAMA Permit on the property located at
Lot 25, Canal 6, Section A & B, 1 Pender Street, Ocean Isle Beach, North Carolina. CAMA
regulations require me to notify you of my intentions. I have enclosed a copy of my permit
application and a copy of the drawing of my proposed project.
If you have any comments on the proposed project,please contact Justin Whiteside,local CAMA
LPO for Ocean Isle Beach at 910-579-3469.
Sincerely,
iti"g4'
Charles W. Fox,III
Charles Fox Homes, Ltd.

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Locality ' 1 Pender Street Permit Number
GENERAL INFORMATION
LAND OWNER
Name John Mohr
Address 273 Sedgefield Place
City Ocean Isle Beach State NC Zip 28469 Phone [phone]
AUTHORIZED AGENT
Name Charles Fox Homes, Ltd.
Address 16 Causeway Drive
City Ocean Isle Beach State NC Zip 28469 Phone [phone]
LOCATION OF PROJECT 1 Pender Street, Lot 25, Canal 6, Section A&B,
Ocean Isle Beach, NC 28469
(If not oceanfront,is waterbody natural or manmade?)
DESCRIPTION OF PROJECT Residential
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Oceans Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline
PROPOSED USE
XX Residential Commerical/Industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT-UPON SURFACES (such as driveways, etc.) within 75 feet of the estuarine shoreline, or 5'
ORW shoreline, or 30 feet of the public trust shoreline.
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING 3005 Sq Ft
SQUARE FOOTAGE OF SITE 6100 SF
(1TF-TPR PPPMTTC Tki(dV RP 'RPM rru1n• v—,.:.. rr,._1_

STATEMENT OF OWNERSHIP
I,the undersigned, an applicant for a CAMA minor development permit,being either the owner of proi
an AEC or a person authorized to act as an agent for purposes of applying for a CAMA minor develops
permit, certify that the person listed as landowner on this application has a significant interest in the re:
property described therein. This interest can be described as: (check one)
an owner or record title,Title is vested in , see Deed Book
page in the County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
xx if other interest, such as written contact or lease, explain below or use a separate sheet and attach
application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affit
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to ap
a CAMA permit.
(Name) (Address)
(1) Peter & Juanita Fickling, 3056 Sides Drive, Connelly Spring. NC 28612
(2) Frank B. & Peggy R. Dean, PO Box 725, Laurinburg, NC 28353
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area whi
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to
particular hazard problems associated with this lot. This explanation was accompanied by recommenc
concerning stabilization and floodproofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit c
and his agents to enter on the aforementioned lands in connection with evaluating information related
permit application.
This application includes: general information(this form), a site drawing as described on the back of this al
the ownership statement, the AEC hazard notice where necessary, a check for$100.00 made payable to the
and any information as may be provided orally by the applicant. The details of the application as described
sources are incorporated without reference in any permit which may be issued. Deviation from these detail
•. . • , c___. ____:• A riovornnino in an AFC without hermit is subject to civil, cI

•
AEC HAZARD NOTICE
3ject Is In An: Ocean Erodible Area High Hazard Flood Area Inlet Hazard:Ai
to Lot Was Platted: SPECIAL NOTE: This hazard notice is re
s notice is intended to makeyou,the applicant,aware development in areas subject to sudden an
pp storms and erosion.Permits issued for develops
the special risks and conditions associated with area expire on December 31 of the third year fo]
ielopment in this area, which is subject to natural year in which the permit was issued.Shortly b
cards such as storms,erosion and currents:The rules of gins on the proj ste, the Local Permit
Coastal Resources Commission require that you determine the vegetation line and setback dista
eive an AEC Hazard Notice and acknowledge that site.If the property has seenlittle change and th
Lice in writing before a permit for development can be development can still meet the setback requii
tied. LPO will inform you that you may begin work.
e Commission's rules onbuilding standards,oceanfront tant that you check with the LPO before the per
backs and dune alteration are designed to minimize,but for official approval to continue the work after
t eliminate; property loss from hazards. By granting has expired. Generally, if foundation pilings
rmits,. the Coastal Resources Commission does not placed and substantial progress is continui
arantee the safety of the development and assumes no renewal may not be necessary.If substantial p
bility for future damage to the development. not been made, the permit must be renewed
Led the Coastal setback line established. It is unlawful to con
e:best available information,as accepted by after permit expiration without this approval..
sources Commission; indicates that the annual ocean
)sion rate for the area where your property is located is
feet per year. For more information,contact:
Le rate was established by careful•analysis.`of aerial
otographs of the coastline taken over the past 50 years.
• Justin Whiteside
idies also.indicate that:the shoreline-'Could move-as •
Bch as feet landward in a major storm. Local Permit Officer
ie flood watersinamajor storm are predicted tobeabout 3 West 3rd Street
feet deep in this area.
eferied oceanfront protection`measure§ are beach Address
mislitnent:and`relocation of threatened structures. Ocean Isle Beach, NC 28469
1rd; erosion control structures such as bulkheads,
3walls,revetments.groitis,jetties arid breakwaters are Locality
ohibited Temporary devices,including sand bags,may
allowed under certain conditions. (910) 5 7 9-346 9
Lis structure shall be relocated Or dismantled within two Phone
ars of becoming imminently threatened.
►e applicant must acknowledge-this information and
4uirements by signing this notice in the below space.
ithout the proper signature,the application will not be
mplete:
-T) r 144 t-L.
)plicanrs Signature
I )

•
BEFORE YOU BUILD
Setting Back for Safety: A Guide to Wise Development Along the Oceanfront
m.you build along the oceanfront you take a calculated whichever is greater.If the erosion rate is greatE
Natural forces of water and wind collide with tons of feet/year,the setback is 30 times the erosion rat
.?,even on calin days: feet.
L-made structures cannotbe guaranteed to survive the The Reasons
of a hurricane Long-term erosion (or barrier island The beachfront is an ever-changing landform.1
ration)may take from two to ten feet of the beach each and the dunes are natural "shock absorbers", t
and, sooner or later, will threaten oceanfront struc- beatings of the winds and waves and protecting i
s. These are the facts of life for oceanfront property areas.By setting back 30 or 60 times the annual
ers: erosion rate;you have a good chance of enjoyir
life of the structure.At first,it seems very invitin
Coastal Resources Commission (CRC) has adopted
for building along the oceanfront.The rules are in- your dream house as close to the beach as ppossil
ed to avoid an unreasonable risk to life and property five years you could find the dream as t
to limit public and'private losses from storms and nightmare as high tides and storm tides tlirei.
-term erosion.These rules lessen but do not eliminate investment.
lenierit of risk in oceanfront development. The Exception
rou consider building along the oceanfront,the CRC The Coastal Resources Commission recognized
is you to understand the rules and the risks.With this rules, initially passed in June of 1979, might
Arledge you can make a more informed decision about hardship for some property owners.Therefore,tl
re and how to build in the coastal area. fished an exception for lots which cannot meet tl'
requirement.The exception allows buildings in fi
Rules setback line if the following conditions apply:
n you build along the oceanfront coastal manage=
t rules require that the structure be sited to fit safely (1) the lot must have been platted as of June 1, "
the beach environment: not capable of being enlarged by combining with
land under the same ownership,(2)developmen
:tines along the dceanfrontmust be behind the frontal as far back on the property as possible and in no
landward of the crest of the primary dune and set. than 60 feet landward of the vegetation ling
from the first line of natural stable vegetation a dis- development can take place on the frontal dune(
equal to 30 tunes the annual erosion rate(a minimum construct bn standards on piling depth and squat
feet):Large structures(inulti famil.yresidentialstruc- must be met and (5) all other CAIVIA, state
greater than,5,000 square feet and non-residential regulations must be met
hires greater than5,000 square feet)must be set back
the first line of natural Stable vegetation a distance The exception is not available in the Inlet Hazarc
I to 60 trines the annual erosion rate or=120-feet,: To determine eligibility for the exception,the Loc
Officer will make these measurements and obser
LolSETBACK I . SETBACK FIRST LINE OF required setback from vegetation line.
l: STABLE exception setback(maximum feasible)
160 x ANNUAL' 30 x ANNUAL( NATURAL
I] AVERAGE AVERAGE VEGETATION rear property line setback
u IEROSION I EROSION I p y
DUOiRATE RATE
i m2..allowable square footage on lowest fl
I . lot area as calculated from vegetation line
piling length needed to extend 4 feet beloi
RUE (SMALL
RUCTURES) I STRUCTURES) I I

•
•
fE DRAWING/APPLICATION CHECKLIST
Ise make sure your site drawing includes the following information required for a CAMA minor develop-
it permit. The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you
quested.
(SICAL DIMENSIONS
label roads
label highways right of ways
label local setback lines
label any and all structures and driveways currently existing on property
BICAL CHARACTERISTICS
draw and label mean high water mark
draw location of on-site wastewater system
u will be working in the ocean hazard area:
draw and label dune ridges (note height)
draw and label toe of dune
identify and locate first line of stable vegetation
draw and label setback line under CAMA
draw and label topographical features(optional)
lu will be working in an estuarine shoreline area:
draw and label landward limit of AEC
describe terrain(slope)
rELOPMENT PLANS
draw and label areas that will be disturbed
if a house is to be placed on lot,describe location of house
note size of piling and depth to be placed in ground
draw and label all areas to be paved or graveled
describe composition of surface
note and list fully all trees and vegetation to be removed or relocated
show landscaping
'E TO APPLICANT
Have you:
*completed all blanks and/or indicated if not applicable?
*notified and listed adjacent property owners?
*included your site drawing?
*signed both application and statement of ownership?
*enclosed the$100.00 fee?
*completed an AEC Hazard Notice,if necessary?
FOR STAFF USE
Notice Posted Final Inspection Fee Received
Lnsnec-Hnnc

pace
ife.. 2
DER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
;omplete items 1,2,and 3.Also complete A. gn•
em 4 if Restricted Delivery is desired. 41111.1M\iii. ❑Agent
'rint your name and address on the reverse X �� r,� ■
o that we can return the card to you. iced by(Printed Name)t (.„'' C.;pate•
ttach this card to the back of the mailpiece, •/- ,,��
r on the front if space permits. 7�•
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fi
D. Is delivery address different '. item 1? . es t
e Addressed to: If YES,enter delivery address ID 1
V V(f ff�I i T7e4 i GCS/A/9
3oSZ S/� 7 2,� 91
2/.X (i SP/7 q,S, i(/( 3. Service Type
7 ,Certified Mail 0 Express Mail
to ❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
rticle Number 7002 0860 0005 3217 1859
-ransfer from service,
t 102595-02-M-1540
DER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
:omplete items 1,2,and 3.Also complete A. Signature
em 4 if Restricted Delivery is desired. /�� 0 Agent
� ✓
tint your name and address on the reverse X 4 € GL' lie4 0 Addressee
o that we can return the card to you. B. Receiyed by(Prin d Name) C. Date of Delivery
ttach this card to the back of the mailpiece, /I
r on the front if space permits. k/5 A
D. Is delivery address different from item 1? 0 Yes
rticle Addressed to:
If YES,enter delivery address below: ❑ No
PO 130 X 7 z 5"
3. Service Type
AUK' r�1 w ) C" rpif Certified Mail 0 Express Mail
3 .5,3 0 Registered 0 Return Receipt for Merchandise
�C u ❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
rticle Number 7002 0860 0005 3217 1866
ransfer from service lab,
'arm 3811,August 2001 Domestic Return Receipt 10 2 595-01-M-2509

(000•41;jiaTh
CHARLES FOX
HOMES
October 14, 2004
Frank B. & Peggy R. Dean
PO Box 725
Laurinburg, NC 28353
Dear Mr. & Mrs. Dean:
Enclosed please find a notification/waiver for a CAMA dock permit for 1
Pender Street. You should have received or be receiving CAMA building
notification within the past couple of days for the same site. This
notification is strictly for the dock.
Please check and sign the notification/waiver, make a copy for yourself
and return it to us as soon as possible.
Should you have any questions, please contact our office at (910) 579-
0908.
Sincerely,
46c-ety
Judy Andricak
Office Manager

CHARLES FOX
HOMES
October 14, 2004
Peter & Juanita Fickling
3056 Sides Drive
Connelly Spring, NC 28412
Dear Mr. & Mrs. Fickiing:
Enclosed please find a notification/waiver for a CAMA dock permit for 1
Pender Street. You should have received or be receiving CAMA building
notification within the past couple of days for the same site. This
notification is strictly for the dock.
Please check and sign the notification/waiver, make a copy for yourself
and return it to us as soon as possible.
Should you have any questions, please contact our office at (910) 579-
0908.
Sincerely,
dy Andricak
Office Manager

el4.-04 DOCK .vO•
'1
DIRECTIONS FOR OBTAINING A CANIA GENERA
PERMIT for a PIER, DOCK, BOATHOUSE/LIFT
To obtain authorization to construct a pier, you must submit the following items to your
CAMA Permit Officer:
1. Signatures of no objection to the pier, from both adjacent riparian property
owners.
Fill out the attached forms, complete with drawing of the
proposed pier, and have your neighbors sign and date in the
appropriate place.
If your neighbor will not sign the form, or lives out of town,
you may send the form to him, certified mail/return receipt,
and 10 days after their date of receipt (which is listed on the
green cards returned to you by the Post Office) the permit can
be issued,-even if no response has been received.
LIZr If any part of the proposed pier is located within 15 feet of the
property line or the Riparian Access Corridor line, the
applicable neighbor must check the box to waive the 15 feet
setback requirement. A signed form, without this box
mod., does not constitute a waiver.
.
The Riparian Access Corridor is not the extension of property
lines out into the water. It is established by two imaginary
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lines that extend at a 90° angle from the channel of the
waterbody to the highground property corners. Your Local
Permit Officer can help you in determining your Riparian
Access Corridor. In some cases, a survey may be required.
2. Scale drawing of-the proposed pier. Your drawing must include the
following ing information (see attached example drawing):
Your name and project address
Names of adjacent property owners

SECTION.1200-GEt\ Al,:PERhIIT FOR CONSTRUCTION OF PIERS:
ESTUARINE AND PUBLIC TRUST WATERS DOCKS:AND BOAT HOUSES LN
15A NCAC 0711.1201 PURPOSE
This permit will allow the construction of new piers,docks,and boat houses in the estuarine construction of new piers and docia within coastal wetlands AECs according to the authority public mist chars�,_ 1e 00
and according to the following guidelines. This permit will not apply to the Ocean H provided in Subchapter 7J.1100
a�r-d,qEC •
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Bistory Notc: Authoring G_S-113A-107(a);1 J3A-107(1));113A-113(b); I13A-118.1; 113„-124;
ff.March 1, 1984.
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15A NCAC 07H-1202 APPROVAL PROC rT)TJRES
(a) The applicant must contact tine Division of Coastal Management and complete an application form Q
• development The applicant shall provide information on site location,dimensions of the °- =approval for
address. project ar
..,and his name and
co) The applicant must provide:
(1) confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objections to the proposed work;or
(2) conitzmation that the adjacent-riparian property owners have been notified
woe)' Such notice shall_instructad adjacent by certified mail oftheproposed
developmentwork..
1 property owners to provide any comments on the-proposed
in writing for consideration by permitting officials to the Division of Coastal Maw
within 10 days of r.c-pt of the notice_,.and,indicate that no response will beManagement
DCM staffthallrevieu•all conmienLs and interpreted as no objection
d�'m�e,based on their relevance to the-potential impacts of the
proposed project,if-the proposed project can be approved by a General Permit IfDCM stafi fmda that the
c®.errs an worthy of more in•-depthrview,the applicant shall be noticed that he must submit an
application for amajor develops earpermit
(c) Approval of individual projects.shall be aclmowledoed in writing by the Division of Coastal Management and the
applicant.shall beprovideda copy of this Section. -
(d) Conn crjo 1ntbe.comple_red witltin90 days of the approval of the
(e) .Any modirication or addition to the permit or the peunit expires.
AnmeIIt
approved proje:t shall-require prior approval from the Division of Coastal
1iisrorvlvoss: Auinarirn G s 1134-107(a);113A-107(b);113A-113(b); 113A-118.1;113.4-124;
.f March 1,1984;
Amended jj.August 1, 1998;January], 1990.
.15A NCAC OiH_ 203 T�MII FE- - -
Tne'applicant must pay a permit fee of one hundred dollars(S 100.00)by check or money orde-,payable to the Denartrnent
.Fi isrory Nov.: Authoring G-S_113A-107;J 13A-1 13(n);.J 13A-1 J 8.1;113.4-119,•113-119_1; 113A-12•e,-
^fI.March 1, 1984;
Amended.Ef August 1,2000;March 1. 1991.

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ur1 the peopos d pier is located betu•�long piers within 200 feet of the a Hier shall no;be lone than the ier h- ppiican;'s propom�, However, -
P ..ad lint erablisbed by the adja` width of me
body. ni piers. lone scan l;;the of the
(n) Piers.noels and boat houses stall no:ins-jet-_with the are-
of 1 feet bctw_ -ss to any riparian property.and shall have
-�art-part of the pier and the adjacent nropem•lines eetaded into the Hater at the a minimum
the shoreline. um s:
The minimum seraarits provided in the rule may be waived bee Pointe that they in
ownet(s),or when two adjoining riparian owners are co-avoii�snts.Should the ei a?tL--n aCgr--asp;of the adjacent ri
of the tti=comme--s,the appiimnt shall Obtain a written property be sold'hefor-constr
s-titrnit itto the anent with the new owner vai "
Divisi®ofCoa_stalManag�tpim-tnmitiatinganyd„e elopm,. r `rom�ouse. t
•of division ofares of riparian a=ess shall be EStabltshed along of the pier,noel:,or boat house. TI
prop:ty,tb�craw a line by Q�u a line the chann_1 or dt�,uat=-, in front
pi up'rty lincrueets tar ua1-'s a Anp to on ne ante
enamel a°�t IL int_-rsea:with the-shone at in-point the u
Ii �. d byrefer sate of thisP.tile�l�=�^�rulras --�=z.tn the roved diz�
applied to snoreline cnni-lgurations. C p "am ttajned
the Division of Coastal idanaren:vut Ashen shoreline coniiR Copies of the d icular may be rj Marion isobtained
achieved,tnr itr � such that a p wall b=-aii�r_d m mR.r'tht iurmtt of this Rule to the D`rP�dictilar aIi�ent
(o) Piersandmooringjaci it:iesshall bee dtsimatd to nl 'm �'more thancablt.
provide dot±in^spate for no two'boats.
Cu) Atrpiimntsica-nuthorization to consn-ucta dock orpier shall-provide notice of the
part of a shellnsh franchise to leas-over which th_-ptoposrd noel:orpier would Tld. Trt a apnij t h foe the �etnd True m-oam-e
apooramitytomarkanavi"ationavutriromtile ertotheedeeapnii tsh�lallowthc
(q)The dial-am shown:below illusnams the-vat-ionsIn of tar lease.
shoreline corn-mutations.
riiston'lvor=: Authority G.S.113A-107(a);113.1-107(b);113R-113(b);1134-118.1;113A-1 74;
%March 1.1984;
..tfram3ded.EffDemnber 1.1991;May 1,1990;March 1. 1990;
RPC Objedionnu`.to.nmbigicilp_Eff March 18,1911;; -
Amended Eff..efuoust J.1998:April23..1993.
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DN��SON OF COAST L__12121.112%,Ggiarr
An,T_ACENT RTPARIkN PROPEYTY OWNER NOTIFICATIONJWAIVER -E�28M
Name Of Individual Applying For Permit : Charles Fox Homes, Ltd.
Address Of Property: 1 Fender Street, Ocean Isle Beach, NC 28469
Lot 25, Canal 6, Section A&B, Ocean Isle, NC
(Lot or—Street--#, Street or Road, Ciry & County
I hereby certify that I own property adjacent to the above
referenced property. The individual applying for this permit ha:
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.
VI have no objections to this ro p posal _
Tf von have objections to what is being propo 0
d_, please rho
Division of roast-al ManaaPmeni-Y 227 Cardinal Drive Extension,
Wilmington„ North Carolina, 2.8405 or call 910 39S-'�gnp wi t-hi n l j
days of rer•einr of this nnri re No responSe is ronsi dpred the samF
as to objer ti on if you have been notified_ by Certified Mail
WAIVER SECTIOi
I understand that a pier, dock, mooring pilings, breakwater, boat
house or boat lift must be set back a minimum
distance of
15 ' i-ron
my arm of riparian access - unless waived byme.waive the setback, you m„Gt- (If you wish to
initial the appropriate blank below_ )
7 do wish to waive the 13 ' setback recuire am_n t
.
✓ I do not wish to waive the 15 ' setback requirement.
73
Siyu Names r,�, L

.11/18/2004 09:47 9105756799 EDB ASSOC PAGE 01
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910-579-0908
PAY TO THE N .1l C m �C ORDER OF I$ 5 00 '
// 11 `
r7ct-,e- , 17- " - ,
MEMO ���-�����~�-AUTHORIZED SIGMA URE
000999130 1: 253 27 235Si: L 25700 L 2970
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