41540D - Shaw

eCAI1fiA/ '[ REDGE & FILL N° 4
N ERAL PERMIT Previous permit#
New J Modification Complete Reissue Partial Reissue Date previous permit issued
•ized by the State of North Carolina,Department of Environment and Natu Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 1.1 . /1 b
ules attached.
Name R A./ sh.4 W Project Location: County Z%AN SW .%C.1
o` ,) 7 _) cf..4 4 ► f Y7-5-/=1 5 Street Address/State Road/Lot#(s) p 7 1,
i-, 0,21y State/✓° ZIP ,)gvc:,)-- f=A 4 ; t f fS 1&
(110) 7 3`j-„)°1U(.0Fax# ( ) Subdivision 5e.,1 4 ; X e c s-1 tr-- I
edAgent ¶IrA Ile,..)-e-C1 City Syrply ZIP De/6
❑CW IAA L 4 IA ES l PTS Phone# ( ) River Basin L. 4
❑OEA ❑HHF ❑IH -UBA ❑N/A
Adj.Wtr. Body A nW w at'/!
❑ PWS: ❑FC:
yes / no, PNA yes / Crit.Hal). yes / no Closest Maj.Wtr. Body AS tn/w
Project/Activity 6,„‘lcµ F 41> k ?IkC FM Fr, k-
(Scale: /'' ,i
:k)length
(s) _ Al VJ V"l
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er(s) 7 i 6 e o f 61,1 Kim t
f) i
igth
nber I
0 I 0 r C Xi$ti A.J vo, i t �� 8'
if Riprap length I b
distance offshore
x distance offshore \ti � '
J'
cannel 1
hK Q
>ic yards c J i-' .f .
ip i
se/Boatlift �^" � .-.70 7 L, 7 0 ? , �.
illdozing
.� � � ?i4i E L` S>f1ft t
1
/�6Q r
Length �d y ---7-' k _ -
not sure yes �io)
s: not sure yes A .{ .
ium: n/a yes (� ` J
yes (�)
\ttached: yes .'""' (ii^✓ii L �"'` .
-ig permit may be required by: 3R4ti S4//C IC -U • . 1 I See note on back regarding River Basin r

iy 25 05 12: 39p Frank Snow 4869125 p. 1
Ma g5 05. 12:34p fly trap farm 866 838 3276 p. 2
•
DIVISION OF COASTAL MANAGEMENT
ADIALENT RIPARIAN PROPERTY OWNER NOTIFICATInN,WArVER FORM
Nara of Individual Applying rot Permit: � r -
Aadresc or-Property * D Q
(Loi or Street#, Street or Road)
Ste{ jf c a(Lt.,S w : ch.
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development they
are proposing. A description or drawing,with dimensions, should be provided with this letter.
1/ I have no objections rn this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 91U-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
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 set
bek a minimum distance of 15' from Arty area of ripariva acre»-unitn waivcdl by Mc. (1f you
wish to W:tiVC the setback,you must initial the appropriate blank below.)
17 I do wish to waive the 15'setback requirement.
t do not wish to waive tlic t 5'setback requirement.
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S�gFt Ivar�ne Date
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Print Name AVA
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Telephone Number with Area Code -T G•.._,,,,,. .�..
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