41488D - Wagoner

L AMA/ I 1 DREDGE & FILL \19 4
kEN ERAL PERMIT Previous permit#
,New _Modification Complete Reissue EPartial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natur sources
:oastal Resources Commission in an area of environmental concern pursuant t 15A NCAC 7 L/ , i/DC)
BRules attached.
:Name r 3R t4(,f .b . ti/A 0 N Tg . Project Location: County ?..)ifN S 1A.1 C(C
1 t(ii;h 0J 00� 9PR ,(R . Street Address/State Road/Lot#(s) L.4 q 3
1NA4pi 11 S State A/C ZIP) 011t. I S4 /r rP (14 4,11
(71)'-')D to.) 1 3`J 3 Fax#(let) 775 - fif ifJ `I Subdivision SE Q 4., R C C off; c
BdAgent ;,, t ( )=(4si ( &q 1 CoA14 -) City SU pp1`( ZIP 4)4V
El CW ❑EW PTA ElPTS Phone# ( ) River Basin 1—(41,v j
❑OEA ❑HHF ❑IH ❑USA ❑N/A
El PWS: ❑FC: Adj.Wtr. Body ('i4A i or-A- AZ(,vw nat /r
es / Closest Maj.Wtr. Body A `^"^'
✓ 0; PNA yes / io Crit.Nab. yes / no
Project/Activity €),1K4-,) LA NDLA,64 1 a F (A"An S-EKE f ((6 IDS I VJ'P"{1 ley.,n L ,
(Scale: 'I
:k)length
(s) (9 = (1111'14 Sf44KE7- c
er(s)
,gth LM vA
nber
ll _ �
I/,Riprap length
distance offshore
K distance offshore
annel
T —
u
is yards 3 ( / ` f G j1 4 i
;e/ 11
ip
Boatlift ------
ei
Ildozing - ------
,..7j / 1(i.)7 S /1 A1V
:Length , "
0 AA l 4
not sure yes 6;0 '
not sure yes Cy
um: n/a yes tho
Cjye�S no
ttached: yes no
ig permit may be required by: g/(ile1.j(N I(-KL (�,..,,'f V . See note on back regarding River Basin rt.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER.• FORM
Name Of Individual Applying For Permit: „ l'G/C-e__
Address Of Property: /7 / %/,
(Lot or Street #, Streit oad, City & 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.
I have no objections to this proposal .
•®
If you have objections to what is being proposedl please write the
Division of Coastal Manaaementi 127 Cardinal Drive Extension.
Wilmington , North Carolina_, 28405 or call 910 395-3900 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, lift or sandbags must be set back 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'setback requirement..
I do not wish to waive the 15'setback requirement.
/". ) �✓� i��� ,c o AMA

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION:WAIVER FORM
Name of Individual Applying For Permit: j5,72 L{y,e 6(1 , ,
Cam°
Address of Property: / 2'7 .,tQA . A i_Zll_. - Caiva l 1-4-- /3
(Lot or Street 4, Street or Road)
Ldrditt
(City y)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. . •- scription or drawing, with dimensions, should be provided with this letter
dEma I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3'
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must bi
bck a minimum distance of 15' from my area of riparian access-unless waived by me. (If
wis i i waive the setback, you must initial the appropriate blank below.)
/1 -Ar I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.

AGENT 323436 DATE 060905 82-40/1021
TIME 1505 02 gI°I� V V
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