41584D - Pollert

',CAMA/ DF#EDGE & FILL N9 4
3EN ERAL PERMIT Previous permit#
Mew _Modification _!Complete Reissue Partial Reissue Date previous permit issued
-ized by the State of North Carolina,Department of Environment and Natura esources ---)
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /#1- ) Za
(Rules attached.
t Name ID E -rr A2 ? f..s... t 12.1 Project Location: County C)►D3Lz J
LI 07 O i—i T 4 's-r" Street Address/State Road/Lot#(s)
u 0.G L,.S? ‘i State1J L ZIP z-aq LIS. 40L6 LA"
--r -
(01t3) 3 )10 V-)g$ Fax#( ) Subdivision CD ' 7 S -VI L 12 S -7>rA'
ed Agent -N* TI N o(L,z. 1 x;1_Zu (N City`jv.--c ta---r-'/ ZIP Zia 4
cw [ kW TA ❑ES ❑PTS Phone# ( ) River Basini-.A?L'
OEA ❑HHF ❑IH UBA ❑N/A `� P
ElAdj.Wtr. Body Csa IJ A L L 4..1"--1), (nat.6
PWS: ❑FC: \\/
yes / no i•PNA yes / Crit.Hab. yes / no Closest Maj.Wtr. Body
Project/Activity i^)S►►N L-L- (o VL aj. 0:11 L = F_1 SbJ E I`T6171, Is.)V `j j J
'3 X b v ,,,U ER p.,-,a. 2- (Scale: )' = .
:k)length
(s) ,
er(L\ 3) )( 113,6
igth
nber
I/Riprap length
distance offshore
x distance offshore
annel � ►� L_
1/4
lic yards
ip
s eti. I X II
3 3
r..
,iidozing
8• :1
!Length 55- N t
yes no R 1
4
not sure yes P
urn: n/a yes al L r l.-
yes Sid
ttached: yes no
1g permit may be required by: 5",it. c-D1 - See note on back regarding River Basin rt

� CI 13
I
1
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: if 12,1 1
Address of Property: 7406 S 5CV'I (> fey - a-
(Lot or Street#, Street or Road)
Dtis(/
(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.
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 910-395-3S
within 10 days of receipt of this notice. No response is considered the same as no objectioi
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
AMA

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
me of Individual Applying For Permit: :-"Dee.,0b4-1? � (_e.E,¢r-
dress of Property: /o G
(Lot or Street#, Street or Road)
•
(City and County)
:reby certify that I own property adjacent to the above-referenced property. The individual
flying for this permit has described to me as shown on the attached drawing the development they
proposing.. A description or drawing, with dimensions, should be provided with this letter.
ZI have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coastal
nagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
hin 10 days of receipt of this notice. No response is considered the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
Lderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
)ck a minimum distance of 15' from my area of riparian access-unless waived by me. (If
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.
Q-gd �. �-�a.�
.Name Date

SNEADS FERRY, NC 28460 66-19/530 g►
[phone] f"
PAY TO THE f1 \ Al $ I 0 • 9
ORDER OF t L'' ✓ • ' T
iGu iZ G f'LF,-Lt a of -xe.53 9r Lam' rS —
r
1U,MEMO /� , 11/5tx� fz/'', - L�//3 tsl/16 AUTHOR RE
ii'001-, 73711' 1:053000 L9661: 0006 50 5 2 199011'