40050D - Westbrook

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CAMS►/ 11 DREDGE & FILL . ', , l!
3yENERAL .PERMIT ' t Previous permit#
rNew 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 7ig., (Ze2c,
ElRules attached.
:Name 46,71 juG ST 8(Lop t Project Location: County 3e„,Vl41CG-4
Street Address/State Road/Lot#(s) Zcir /Q
State ZIP 3 ztAt-h-4 SS L 't
( ) Fax#( ) Subdivision
ad Agent 47111 lleiv'77 '4,.. * 3i67 XCity ,,4(e,a! /load ZIP 2 1
CW S.yEW PTA _ES ❑PTS Phone# ( ) River Basin 1i1.0M,
❑OEA ❑HHF _IH UBA ❑N/A
Adj.Wtr. Body /et/G✓ p /r
yes /6 PNA yes / (9 Crit.Hab. yes / no Closest Maj.Wtr. Body kil/I
Project/Activity Pt f 6 5e 1 3'eT t,F7 d l� i L I Roof— x,5.7 A,.,e_ -
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f ig permit may be required by: ie /©I See note on back regarding River Basin n

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JUv-15-2005 C5:15 COGENTRIX ?u4 527 4413 12
plviStt11LOF QOtkSTAL MANAQ$1vCENT
1V
Name of Individual Applying For Pert- LA'oic. ---
Address of Property: 0 ar r L' eN Y3 tuh
(Lot or Street 0, Street or Road;
Qr S1% c'�
(Ci„ and County)
I hereby certify that I own property adjacent to the above-tieferenced property. The individual
applying far this permit has described to me as shown on the;'tacked drawing tit e de\'e:opment the;
ere proposing, A description or drawing, with dirnensions,,should be provided „•ith t'.11s lent:,
I have no objections to this propbsoi.
If you bzs'e objections to what Is being proposed, please write the Division el Coastal
Management, I37 Card,nal Drive Extonsion, 1\ilrniugton, NC 1S40 or call 910.395.3900
within 10 days of receipt of this notice. No resp;ase Is coposidered the same as to objectlaa If
you bore been notified by Certified hIIIL
WAIVER SECTION
I undermaod that tt pier, dock, l:nooring pilings,brealivaer,boat house or boat lite'ntWtt be set
bek a mitaimun distance of 15' from my area of riparian access •aides! waived by nit. (If you
wish to wdive the satbuch,you must initial the appropriate blank belolt.)
I do wish to waive the 1 s' se:hoe&requirement.
I cuot wish to waive the 15 setback requirement.
Sign Nil D.te
Print Name • AVA
(.7.e73-0- 41761 itICCIENR
Telephone Number ' with Area Code ►,r.t,...»...,,,..,.«
PCENRGnc.l w w� RYMitt
S:�cema%shrlls\a;oarlanoroaertv.frm i

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/\VAIVER FORM
Name of Individual Applying For Permit: Ai if., 60 6,tw/c
Address of Property: 33 0 tklar ktr 5'j-((v 1 c.Q n 13�qc- /t/c
(Lot or Street tr, Street or Road)
(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 drawinz 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 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
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
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' setback requirement.
I d;.: not wish to waive the 15' setback requirement.
S' Na
�ae
-�. �'�`��♦

1-20-2005 03 :08 PM 9100463131 P.O
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PAY TO THE C D
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BB&T
BRANCH BANKING AND TRUST COMPANY
SUPPLY,NORTH
CAROLINNAA ,` l/
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116000095116 1:053 LO L L 2 LI: 5 L913587690116