41469D - Westervelt

(AMA/ DREDGE & FILL `' V 4
'.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
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 71/t /ZOO
"� Rules attached.
:Name Ae,t/ Wet #eri/eI# _ Project Location: County �nd[r
/2- J3DQn i5 1)r. _ Street Address/State Road/Lot#(s)
fQrrip-1E44 State At ZIP 2'6'11-3 5A01{
( ) c20 3 347 Fax#( ) Subdivision
ad Agent City _ ZIP
❑Cw XEW [$PTA ICES ❑PTS Phone# ( ) River Basin 6/It d
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Vi/yilAS frt tk
❑PWS: ❑FC: 1
yes /01 PNA 0 / no Crit.Hab. JI
no Closest Maj.Wtr. Body /OW
Project/Activity fropinta( pit✓/ p/kf bfrx .he4tf C;f
(Scale: /"
:k)length G x V.
(s) /2 t 9-
er(s)
Igth
)Z5 lOenvli5 4r,
nber
i/Riprap length
distance offshore
x distance offshore
cannel
)ic yards it 0
se/ /2 X a Z
o
illdozing 1
s''''''''"""•---...........••• 77/
Length (KO 4, ----o
not sure yes •
s: not sure yes •
cum: n/a yes
yes O
\ttached: yes o
rig permit may be required by: 4a,6/ L, . See note on back regarding River Basin r

)05 13:le From: To:92540502 P.1'5
DIVISION QF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
me of Individual Applying For Permit: .4�i.- \l e5i3 R V L.-
dress of Property: 125 Dt M, ALS Dr.
(Lot or Street #, Street or Road)
(City and County)
ereby certify that I own property adjacent to the above-referenced property. The individual
plying for this permit has described to me as sho\N n on the attached drawing the development the..
proposing. A description or drawing, with dimensions, should be provided with this lene-_
tip I have no objections to this proposal.
you have objections to what is being proposed, please ‘s rite the Division of Coastal
)naaement, 127 Cardinal Drive Extension, Wilmington, NC 25405 or call 910.395-3900
thin 10 days of receipt of this notice. No response is considered the same as no objection if
u bare been notified by Certified Mail.
WAIVER SECTION
nderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift'must be se;
k a minim m distance of 15' from my area of riparian access - unless waked by me. (Tfyou
sh to valve the setback, you must initial the appropriate blank below,)
I do wish to \vaive the 1 5' setback requirement.
I do not wish to waive the 15' setback requirement.
�n Neme Date
/kb a 2- 's
int Name
4 - /7)4 2-v4I3 I►rIIRlea w

305 13: 18 From: To:92540502 P.1/5
DIYISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NQTJFICATIQN/\\'AIVER FORM
.me of Individual Applying For Permit: 1Zc - kMR- \/-! e.svt Vkt L�-
dress of Property: I Z S ')P /4 t 5 D r.
(Lot or Street #, Street or Road)
(City and County)
ereby certify that I own property adjacent to the above-referenced property. The individual
plying for this permit has described to me as sho\N n on the attached drawing the development the.
proposing. A description or drawing, with dimensions, should be pros ided with this letter.
I have no objections to this proposal.
you have objections to what is being proposed, please ‘‘ rite the Division of Coastal
nagement, 127 Cardinal Drive Extension, Wilmington, NC 2S405 or call 910.395.3900
thin 10 days of receipt of this notice. No response is considered the same as no objection if
u have been notified by Certified Mail.
WAIVER SECTION
nderscand that a pier, dock, mooring pilings, breakwater, boat house or boat lift'must be se;
k a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifvou
sh 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.
L1� zu �Y cc�4l�c(�i .L <f /(/ Cj
gn Name J Date
e_ L -2L , L �l DB A7`/
R
int Name •

II to the cti#A4A_
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Fuits—r CITIZENS 945
BANK rc,i-vv.re Pird)34 ir"d Company
www.firstcitizens.com
For
0 53 LOO 3001:0008 6 7 68 ? 30010 61,63
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