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3ENERAL PERMIT Previous permit#
:New -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 _I H j i g V • i '11,,
❑Rules attached.
t Name �LA f., i' SrtGC-1S Project Location: County DtJSI. .--
rl� SrJ.0S 6Street Address/State Road/Lot#(s)
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( ) Fax#( ) Subdivision OLD S21'1LL 125 )?ji%A..-
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❑CW L W ) TA E ❑PTS Phone# ( ) River Basin P►f E
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Adj.Wtr. Body5ru,rr%r Sa.`^✓r (natdi
❑PWS: ❑FC:
Closest Maj.Wtr. Body A.T
yes no PNA yes i' Grit. Hab. yes / no
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igth
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i/Riprap length
distance offshore n4()(Z
x distance offshore Li'r"i S
annel _
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notsur, yes no
not sure yes '
urn: n/a yes (
yes
1tached: yes If:› —
1g permit may be required by: 3 Lk (LC. eri J - . See note on back regarding River Basin ri
' DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO 111.ICATION/WAIVER FORM
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me of Individual Applying For Permit: U kr A ahehept
dress of Property: I S" Si
(Lot or Street#, Street or Road)
a ,/, 2- O.
(City and County)
,reby certify that I own property adjacent to the above-referenced property. The individual
lying for this permit has described to me as shown on the attached drawing the development they
proposing. A desc ' tion or drawing., with dimensions, should be provided with this letter.
I have no objections to this proposal.
'ou have objections to what is being proposed, please write the Division of Coastal
Qagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
iin 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
derstand 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. //
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OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
items 1,2,and 3.Also complete A. Sigpature m o
lestricted Delivery is desired. ❑1 Agent 0 m H
name and address on the reverse { ��NiAVOiiii i 7.
❑Addressee O i
can return the card to you. g R -�r C. Date of Delivery „ m
s card to the back of the mailpiece, ,.� es-
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front if space permits. ���►� ��
D. Is deliveryaddress different from item 1? 0 Yes
essed to:
If Y S,lister delivery afli ess below: 0 NoIt
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4. Restricted Delivery?(Extra Fee) r]Yes c
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