41566D - Smith

1CAMA i ''.'bREDGE & FILL N? 4
j.ENERAL 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 F . //O�
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC •
❑Rules attached.
:Name G\,.. i<A01 �41/ ;g • Project Location: County 4,/4‘,/,-- �uff,&,//
gQ 0 It 7' i'ol Street Address/State Road/Lot#(s)
',//n1/ �//A State/W ZIP Z S y ,7/1q eP8 ,� /f /,/G*,/ �/",
(9/v) !6/4.SIP/Fax#(ge_) 99/ &4y Subdivision ,554,4;/s 41•'40,00/
'
ad Agent sfl?d '(4 1Uj City /1////h/wry j ZIP 2g11
ElCW ACV lkfi A VEs ❑PTS Phone# ( ) ✓_. ,a a River Basin e'rG/OI ,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A /f�
Adj.Wtr. Body J hi;i,/ C/Yt/4*-- (nat
❑PWS: ❑FC:
des /� PNA yes / Crit.Hab. yes / no Closest Maj.Wtr. Body &{ems 1// fir' ..5eeed+
Project/Activity s f l evy h1//>`�,1� 7 /4,1 !�/'t" /� i"/
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igth
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im: n/a yes A 8ok 7,,,7,,,r! �/
7 /'//s.- .Z(,
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ttached: yes fi'q `
g permit may be required by: �/�r /Jj /ice/4 ' . See note on back regarding River Basin ru

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
tame of Individual Applying For Permit: ---SP1S b'N S vv ; k
,ddress of Property: 'O$ \-cA- v;tom 1)r.
(Lot or Street#, Street or Road)
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individual
pplying for this permit has described to me as shown on the attached drawing the development they
re proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
f you have objections to what is being proposed, please write the Division of Coastal
Zanagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
rithin 10 days of receipt of this notice. No response is considered the same as no objection if
ou have been notified by Certified Mail.
WAIVER SECTION
understand that a pier,dock, mooring pilings, breakwater, boat house or boat lift must be set
ck a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
rish to waive the setback, you must initial the appropriate blank below.)
/6/4____ I do wish to waive the 15' setback requirement.
NI/A I do not wish to waive the 15' setback requirement.
iName Date

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Oie.I -
\1ame of Individual Applying For Permit: ---5/N S p� __
kddress of Property: CE.Q g ,C
(Lot or Street#, Street or Road)
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individua
ipplyinz for this permit has described to me as shown on the attached drawing the development the
ire proposing. A description or drawing, with dimensions, should be provided with this letter.
1/ I have no objections to this proposal.
:f you have objections to what is being proposed, please write the Division of Coasts:
VIanagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390C
within 10 days of receipt of this notice. No response is considered the same as no objection ii
ou have been notified by Certified Mail.
WAIVER SECTION •
understand that a pier,dock, mooring pilings, break-water, boat house or boat lift*must be se
)ck a minimum distance of 15' from my area of riparian access- unless waived by me. (If you
vish to waive the setback, you must initial the appropriate blank below.)
AO_ I do wish to waive the 15' setback requirement.
Ni/A I do not wish to waive the 15' setback requirement.
( 1P: CTVEI
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