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,I.AMA/ I-Ji DREDGE & FILL
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;AN ERAL PERMIT Previous permit#
new I1Modification !Complete Reissue CPartial 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 I 5A NCAC 71/ /200
des attached.
Name/ 0YI4 5 R. r?JL Project Location: County 6 4/t..-s /C/C
i 50$ iW Al SUN Ayr.; , Street Address/State Road/Lot#(s) Lo+ /(-)
4+ qI,e ., 0e State SC ZIP 151`
6�"1 t/a► - •)y,}'U Fax#(V3) iSt#'AS 3 Subdivision 0054N thI U R s y7g7 S
;d Agent ,1/�/4- City(,-/4134 s/-/ _ ZIP .D8`1f(,
?'CW YIIN LSE Seel ❑PTS Phone# ( ) River Basin 1(40116.
OEA ❑HHF ❑IH E UBA ❑N/A Adj.Wtr. Body QSW w nat
PWS: ❑FC: ,qTW I•V
no ies / PNA yes /�ic Crit.Hab. yes / no Closest Maj.Wtr. Body
Project/Activity P�,UA'& / 'r cl
(Scale:/ = y4
k)length 61 X 3;,5 ��
:s) /..) X•7�, PC:tfijn IV 1.1 ` /5.
sr(s) r G I .
gth 7 i
fiber '4
/Riprap length yr/
distance offshore
1 c distance offshore 5j
innel +, '\�`
is yards
e/poatlift /5 X.)y A
Ildozing ��i
/oVT_ g ,Xf6 , � �r..
R- :
29
Length /00 i di
not sure yes Cy
not sure yes I
n
im: n/a yes 69)
c1 I`
yes 5Uhi'S 6F
ttached: yes Q t
pl 4- utg permit may be required by: 7U /fV pH C i4/� 5,i 16 U
See note on back regarding River Basin ru

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Rx Date/Time JUL-27-2005(WED) 09:48 575 9005
Jul 27 05 10: 47a Reception 575-9005
vi vJ 4AJLM yr tvIABAS.M IN. .
7AC NT PROPERTY OWNER NOTIWICAUON/WAIVER POR.M
Name of Individual Applying For Permit: i�p,,�. s r2 , A
Address of Prope,-v: (A-{ LO 0 rot.— s
(Lot or Street t, Street or Road)
4-a 6.4 1u.
• (City and County)
.I hereby certify that I own proper• adjacent to the at,oveleferenced property. The individ;:al
• zoolvi^s for this ter nit has described to me as shown on the z:,: ched d-awing the de':eiopme-,t they
are props' desc'r ption or drawirta,with dimension should be provided .,kith this IeZ-
I have no objections to this prooesz!.
If you ha -e objections to what i5 being proposed, please write the Division of Coastal
Manactiment, 127 Cardinal Drive Extension. \\limin2t0o. NC 2S40_ cr calI 910-:9E-;900
within 10 days or receipt of this notice. No response is considered the same as no objeatioa if
you have been notified by Certified Mail.
WAIVER SECTION
•
I under::dad ta:t a picr.dock,mooring.piiinas,breakwater,boat house or boat lift"must be se:
Fick n mi:imu m disraoie of 15' from m'y area of riparian access -unless waived by me. (If you
wish to 'N. iV a t_o setback. you must initial the ]pr•r;,1,ria_t b:nh be!o v.)
•
I c: with to waive the 15'
I not wish to waive the 1 setbsck rec_irerr,en:.
4°14 -z
•Si I�2'«e � Dace
Print NzrTlc • A` 'A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: ikoma s rQ be.r
Address of Property: Lb-i- I V D (on.— frip.,42,60. gs i re s ( 3 3/j 7--a
(Lot or Street€, Street or Road)
-Ct-Elti t ct s I r c c r..s
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individua
anplving for this permit has described to me as shown on the anached drawing the development the:
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 Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 2S 05. cr call 910-395-3901
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings; breakwater, boat house or boat lift*must be se
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If vo
wish to waive the setback, you must initial the appropriate bi ni-: be!ow.)
I dL., wish to waive the 15. setba_.. rezuirernent.
I do not wish to waive the 15. setback reauirement.
GQ5
Sign Na:ne Date

Message Confirmation Report AUG-31-2005 04:58 PM WED
Fax Number .
Name
Jame/Number 918432805853
?age 2
Start Time AUG-31-2005 04:58PM WED
Elapsed Time 00'46"
vlode STD ECM
2esults [0.K]
State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Michael F.Easley,Governor William G.Ross Jr.,Secretary
FAX COVER SHEET
Date: './' g,Os
No.Of Pa :(excluding cover)
To: .I 01.a/fs From:
CO: CO: NC DCM
FAX#: f'/3.S.S3 FAX#:[phone]
REMARKS: Ah."Pm.,7
127 Conlinnl Drive Extension,Wilmington,N.C.2M05.4845 illepllone(91(1)706.7215 Fox(910)305.064
An equal Opportunity Affirmative Action Employer

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LITTLE RIVER, SC 29566
PAY TO THE
ORDER OF l� i Fi JV $ j V 0, I
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