41571D - Warren

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3ENERAL PERMIT Previous permit#
flew Modification c_IComplete Reissue LiPartial Reissue Date previous permit issued
rized 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 • / Z 00
f ules attached.
t Name M� �ne Nf11 Q�t,y2�tJ Project Location: County i�G►,.)
3 Z. " 1 L l Street Address/State Road/Lot#(s)
)Al,L I5e4A L 1/H State 1� ZIP yLic 13 Z ft1 C.. LE 3b
(°t I O) (01 b- Fax#( ) Subdivision
ed Agent 4.A LL t t City 7t�s 41-4- g4s4A444 ZIP 2a14 L
❑CW t ) ?TA ❑ES ❑PTS Phone# ( ) River Ba‘CA19F c
❑OEA ❑HHF ❑IH ❑UBA II N/A
❑PWS: ❑FC: Adj.Wtr. Body�.AwA�- L fir.•+9 J (nat Qi
yes / Eio PNA yes / lyZ Crit.Hab. yes / no Closest Maj.Wtr. Body ��N S r N
Project/Activity J--N a L L 6.�1211- LL c 1 L' Z x 1 Z, , EI3 a S G
( ko' ) ►-T.)1 CD Z LiL L 5 x I to (Scale: I' Z
ck)length
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ier(s)
ngth
rnber
Riprap length
distance offshore is /� _
distance offshore ( 1 A N A )
tom.
iannel \ ��
)ic yards 1 0
ulldozing
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not su yes no
s: not sure yes ® L 4-
ium: n/a yes G46,
yes
'lttached: yes ® ► '�
ng permit may be required by: �PSA2L ��c�/�' . See note on back regarding River Basin r

' DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ame of Individual Applying For Permit: "/2e (.ram 2ev
ddress of Property: /3 Z L Je,
(Lot or Street €, Street or Road)
�oF5/4-;1 ee 4C/ /V?. zgyys
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individual
Jplvir:g for this permit has described to me as shown on the attached drawing the development they
proposing. A description or drawing, with dimensions, should be provided with this le.—ter.
I have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coastal
Ianaaement, 127 Cardinal Drive Extension, Wilmington, NC 2S40f cr call 910-395-3900
ithin 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.)
I do wish to waive the 1 S sets::k requirement.
I do not wish to waive the 15' setback requirement.
) ' / d c5- 14- 0 .
;i i NaT Date
/42i ri iiii'7 7 _ ..irnr"W"MIMI A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
\ame of Individual Applying For Permit: /"///jc ' ett/t)
'kddress of Property: /3 Z /�G 2 e,2)
(Lot or Street €, Street or Road)
14-4%/ &f / / /{/� Z SL/�s"
(City and County)
i hereby certify that I own proper Ty. adjacent to the above-referenced property. The individual
applving for this permit has described to me as shown on the attached drawing the development they
are proposing. A descriptio or drawing, with dimensions, should be provided «.ith this 'eat:.
, I have objections to this proposal.
if you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 2S405 cr call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
vou 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
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15. sewn_:: requirement.
4, •5• I do not wish to waive the 15' setback requirement.
----._ ,r 4 7‘- ,‘ // E,
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Dat -d0e G '
D
icm Name A— /!-
>1 ,a , , : ,1 �' ..._ ,.,�L / , . ,

4/05/2005
ADJACENT PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Mike Warren's
property located at 132 McLeod (canal lot) in Topsail Beach, NC
Pender county.
I have review the drawing for a boat dock and lift project he is
proposing at that location and, I have no objections to his proposal.
Adjacent owner signature
Print name
Address
Phone #
Date
Any questions please call: Division Of Coastal Mgmt.
127 Cardinal Dr. Ext.
Wilmington, NC 28405
Phone: [phone]

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_ MOMt#U1U-:5 -401i ' 66-19/05:
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