42368D - Wilkinson

.LAMA / DREDGE & FILL y .:<I„
IENERAL 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 15A NCAC )11 ' J
❑Rules attached.
Name L f V o►J VS iI L I.)s ) Project Location: County a►)siLza,.)
c O) ') C-H- bArse_t. Sri t-e S by,. Street Address/State Road/Lot#(s)
) i-n A S PEA-4-1 StateiJL ZIP 2-80-4 G cV:4 Gh W n nG‘` %,...k o►ZE 5
0 I O)3s i—S1$2_ Fax#( ) Subdivision (,►n 4 bw1 c..44.. 5 ,Q—E 5
.td Agent IN i1*--)3t-1 01)4VQ.t,,N)d- Cr.NA ► - Cit)5'E1)A)5 C 12.42.A1 ZIP Zh314`
❑CW ANY IATA C ES ❑PTS Phone# ( ) River Basin 1V14 t
❑OEA ❑HHF ❑IH ❑UBA J N/A y
Adj.Wtr. Body I A D•v1 G 14- /
❑PWS: ❑FC:
'es /V� PNA �/ no Crit.Hab. yes / no Closest Maj.Wtr. Body Q��
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distance offshore �i
:distance offshore --1
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im: n/a yes
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g permit may be required by: ON.5 i.J £ . . See note on back regardin River Basin ru

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�� •�m HERBERT K. LAND, D.D.S., P.A.
DIPLOMATS
Contemporary Orthodontics AMERICAN BOF
OF ORTHODOF
Member
American Ass
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® — ® Orthodontists
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO IMICATION/WAIVER FORM
ame of Individual Applying For Permit L 01 ' 1 LLi
ddress of Property: ��` 1'=' A,) Lk-) ,C-�� .SK1Y.Lt i
(Lot or Street#, Street or Road)
(On)5Lsw�
(City and County)
iereby certify that I own property adjacent to the above-referenced property. The individual
?lying for this permit has described to me as shown on the attached drawing the development they
proposing A description or drawin`with dimensions, should be provided with this letter.
I have no objections to this proposal.
von have objections to what is being proposed, please write the Division of Coastal
nagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
bin 10 days of receipt of this notice. No response is considered-the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
Lderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
)ck a minimum distance of 15'from my area of riparian access-unless waived by me. (If
wish to waive the setback,you mast initial the appropriate blank below.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
C 7// G L)
Name Date
A AMA
-A

OIVCHUJ rcrcm, rvL..4O4OJ OD-1J/b3U(910) 327-3475 fRo'
PAY TO THE A, Q
ORDER OF !Y C. jQ E N. /\- $ 3cc .
N.Pcr HoH0/zr.1� Anl4 /ayj
cdie
MEMO ;74 L- 3 0i- �a 363 - /71-Z 3611 AUTHORIZED SI TURE
0001,89 Lei' 1:0 5 3000 L 9 61: 00065052 L 9 900