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rizedLAMA/ ❑DREDGE do FILLENERAL PERMITPrevious permit#New JModification ❑Complete Reissue ❑Partial ReissueDate previous permit issued
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 r ' ! Z''
Rules attached.
nt Name s RC.1L �11\ . 641 E Project Location: County ©ate w
s 3`a S AT I-- % T? v✓ Street Address/State Road/Lot#(s)
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d ❑CW ylW TA ElES ElPTS Phone# ( ) River BasinViiij TT!
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 51U*•-, P Se.,, ✓J oa
❑ PWS: III FC: _/
es / no PNA es no Crit.Hab. yes / no Closest Maj.Wtr. Body -- IA/ Y"
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length ��_.. -- 14,
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vg distance offshore ... I i_ 1- ._ _ __....—
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ding permit may be required by: tV• 1 OP S W 1 L. g g p.4.. 1A . n See note on back regarding River Basin
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DIVISION OF COASTAL MANAGEMENT 2
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ie of Individual Applying.For Permit 5 lit c K h cG trEE
ress of Property: 3 ' SA it- Ul EG^ C P e /5 CA,4 t
(Lot or Street#, Street or Road)
RECEIVED
•o�7S,it u - d sLoc..) DCM WILMINGTON, Ni
tf rev°
G�
(City and County) 1ti11 Z"9-2005
eby certify that I own property adjacent to the above-referenced property. The individual
ring forthis permit has described to me as shown on the attached drawing the development they
roposin. A description or drawing with dimensions, should be provided with this letter_
I have no objections to this proposal.
u have objections to what is being proposed, please write the Division of Coastal
igement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
a 10 days of receipt of this notice. No response is considered-the same as no objection if
ave been notified by Certified Mail.
_ WAIVER SECTION
erstand that a-pier, dock, mooring pilings, breakwater, boat house or boat lift must be
k a minimum distance of 15' from my area of riparian access-unless waived by me. (If
ish 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 -
1 c )vte, k •
e IX e i / 1 �(/ .Gu P
fame Date 1 ( -s Cl I v

Track/Confirm-Intranet Item Inquiry
Item Number: 7004 2890 0003 2018 1247
This item was delivered on 06/23/2005 at 09:53.
vw.ev.y.,w.a.v..
Signature:
r
Address: :3'No4I Se/ 4()".1114/14)1.,.
Enter Request Type and Item Number:
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lExilanation of Quick and Extensive Searches
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Comp(ete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. f—' C71,
Agent
Print your name and address on the reverse X �� Q Addressee
III
-
So that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
IN Attach this card to the back of the mailpiece,
or on the front if space permits. POu
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
If YES,enter delivery address below: 0 No
CHRLI,SCt NEtTHOcao
G/io cA cco 5,)9 c.4"H/7 LA,/
W/tYCNS7"EP 3. SeryiceType
�. WCertified Mail ❑Express Mail
' El Registered CI Return Receipt for Merchandise
4 Q3 9/ 0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7004 2890 0003 2018 1254
PS Form 3811,February 2004 Domestic Return Receipt
102595-02-M-1540

Track/Confirm -Intranet Item Inquiry -Domestic
Item: 7004 2890 0003 2018 1247 Date/Time Mailed: 06/16/2005 10:37
Destination ZIP Code: 59106 City: BILLINGS State: MT
Origin ZIP Code: 28445 City: HOLLY RIDGE State: NC
Class: First Class
Anticipated Delivery Date: 06/20/2005
Weight: lb:0 oz: 1
Special Services Associated Labels Amount
CERTIFIED MAIL 7004 2890 0003 2018 1247 $2.30
RETURN RECEIPT $1.75
Event Date Time Location Scanner ID
DELIVERED 06/23/2005 09:53 BILLINGS MT 59106 L566723
Request Delivery Record
View Delivery Signature and Address;
NOTICE LEFT 06/20/2005 12:31 BILLINGS MT 59106 L566723
ACCEPT OR PICKUP 06/16/2005 10:37 HOLLY RIDGE NC 28445
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:ONSTRUCTION BANK OF AMERICA
4856
RGINIA LANE
ERRY, NC 28460 66-19/530
327-3475 a8 t)L 5
N• , _ $ <oo, cry
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d` et) DOLLARS =
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4SIGNATE
85Ellin 1:053000 L961: 0006505 2 L9900