42067D - Percill

.cAMA► / 'DREDGE & FILL J\fIr
aENERAL PERMIT Previous permit#
14Qew -Modification 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 15A NCAC /
jyr-Rules attached.
Name 6. Q.EU PE
�R.�Ci�L�- Project Location: County ©t3
i_41 Street Address/State
`Road/Lot#(s)
C v1 Q . S-7 State 1.)L ZIP H s —1 14
( ) Fax# ( ) Subdivision QLb SP'f'1'L-G $ -S el
V
ed Agent I...ZG rrl v S e d4 A i N City, i�1.� ���I ZIP 11
❑CW >kiN ■P'•A ❑ES ❑PTS Phone# ( ) River Basin
❑OEA ❑HHF •IH ❑UBA ❑N/A Adj.Wtr. Body 1. 0 63 nat 4
❑ PWS: ❑FC:
yesi PNA yes no Crit.Hab. yes / no Closest Maj.Wtr. Body
Project/Activity f-:G ( x AT& ip LSI j to \ 1 iJ / '-L. I j,n,o.a
i u CT (Scale:'N J 3
:k)length
(s)
er(s)
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nber
I/Riprap length
distance offshore
x distance offshore
annel M0aI2�N (r 1 jif JG
is yards
ip r
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)2 )1. 12
illdozing 0Q Ck
Length S '
not sur yes no t_
not sure yes (0
urn: n/a yes 427
yes
ttached: no
ig permit may be required by: 51-1 Q G L' See note on back regarding River Basin ri

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: gee, P-0--/Z.417
Address of Property: 1107
(Lot or Street#, Street or Road)
StNY 6 /1330-1.4/
(City and County) /
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter.
v� 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 910-395-3!
within 10 days of receipt of this notice. No response is considered the same as no objectiol
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.
Sign Name Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
/j
Name of Individual Applying For Permit: i 76 , v/
Address of Property: go 5 7 '-=J
P �
4-e6,17-
(Lot or Street#, Street or Road)
(City ounty)
14
I hereby certify that I own property adjacent to the above-referenced property. The individt
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 Coasi
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. i
you wish to waive the setback, you must initial the appropriate blank below.)
j, I do wish to waive the 15' setback requirement.
1 I do not wish to waive the 15' setback requirement.
Sign Mame Date
�9�,. S.:72,7X ©i

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