41479D - Potter

CAMA / 'DREDGE & FILL N9 4
ifiNERAL PERMIT Previouspermit#
New -Modification Complete Reissue __Partial Reis e Date previous permit issued
ized by the State of North Carolina, Department of Environment and ral Resources
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7ff, II 2
IW Cules attached.
Name 6,1 Aftev Project Location: County 4SMst,acft
Gd 36 lo.ar, Lynn i)i. Street Address/State Road/Lot#(s)
'01/z J 5/it i t State Alt ZIP OM C
( )Z75-3/25- Fax#( __) Subdivision
?.d Agent City ZIP
❑CW PI* IfTA 'ES PTS Phone# ( ) River Basin a,'
❑OEA ❑HHF IH UBA N/A Adj.Wtr. Body ,/1/ t (nat /n
❑PWS: ❑FC:
�,� ,� Closest Maj.Wtr. Body QGC.�n
ies /V PNA yes /e) Crit.Hab. yes /v
Project/Activity 4006lpl XJu/kheast
// (Scale: /' ;
k)length
s)
gth fj
fiber +,'r LG (/
Riprap length ' Y
distance offshore j1
distance offshore /I
innel
icyards
p y i i
i 5 0, ,
/d
e/Boatlift
Ildozing
t
J D0
t
Length CO I l /not sure yes 1 6'4 3 GI f /. I n Lyn# l�J p,
not sure yes n
Jm: n/a yes n
yes n
:cached: yes o
g permit may be required by: iteie'lI 5sdil4- See note on back regarding River Basin rui

DIVISION OF C'O&STAI.AIAN4G MENT
ADJACENT RIPEN PROPERTY OWNER NOTTFICAT ION/WAIyvR FORM
Name Of Individual Applying For Permit ale fi /'B��je
Address Of Property: /,/3l A<riV 'f A/Alg b
aaX rs�A� � A/c_ &'41, .sliare-ot
(Lot or Street At, Street or Road, City &County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to tie as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
(. r I have no objections to this proposal.
If you have objections to what is hying proposed please write the Division of Coastal
Management, 127 North Cardinal Drive grllmin_otnn North Carolina,28405_orrall 910 395-
.R900 within 10 days of trreipt of this notice. No response is considered the same as no objection
if you have bin notified by Certified Mail
WAIVER SECTION
I understand that a pier,dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If 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.
Ayx4YA
Signature L, ate ,

DrVICION OF COASTAL M 4 N AGEM)F NT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: 6,e,i
Address Of Property: GG 34 XSAl&s. L�,N � 2!2,
40AiE' ISLAN.61 �/G l3,ede,s,swrc,r
(Lot or Street#, Street or Road, City &County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
..l
I have no objections to this proposal.
If you have objections to what is being propoced, please, write the, Division of Coastal
Man r.ment, 127 North Cardinal Drive Wilmington North Carolina,.7R405 or call 910 395-
1900 within 10 days of receipt of this nosier Nozrsponse is considered the same as no objection
if von have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
' I do wish to waive the 15' setback requirement_
�� /1&nett wish to waive the 15' setback requirement.
F -�-
Sigenature Date
Mr.

17 PRX7 gVivfX %/f?
.4.cof tiv!..i.9 Zf 3...4 <'d V 3 V fill eV .5 141 5 VV./adj..
1
qt/RIX70F/ (71/50c/olid
-
J .1 (
if r ii) /11 ifl A A
/ 1 4
A A (ft
A
/5* )
, .
. 4
1, 1)-
.
•
4, , i,
A
A
____------------
H V n°75 A 3';L"Q‘C •f"I(Ai

PYTOTHE / Q�� I $,.�^^ �g�
ORDER OF C� �( Uv
isie-eciLtz, + J e' DOLLARS el
•
COASTAL FEDERAL BANK
SOUTHPORT,NC 28461
MEMO - -�, ,, yy�y wYaw•
--- ----
I: 253 27 23551: 3 2 580008 7 2" 2750