77945A_Brouthton, T & Dail, Teresa_20210111

CA"A / , DREDGE & FILL
'GENERAL PERMIT
N9 77945
NewIMOdIfication £o[ttplete ReMue `r
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Partial fteIssue ----
As authonzec try the State of Nan Carol=.na, De �e � P�K �ssuetijZ ?) Z4
and the Cna.%zal imdrrt r}fi Err+mnrme rt („
Comm Vision
in an area of erwvorme, KW roncem Pint to ISA NCAC °i
APPlicant Name ) 't' ... r"'iR"�Nil
Prat Location: County
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A hug ;ding permit may be reguted by: ' ?!:g (Af , ja' a See note on back regarding R)Yw Basic, rvies,
flog' Special C4ritlitions
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION]WAIVER FORM
CERTIFIQ MAIL RETU} N RECEIPT REQIlESTEC} or NANO QEt_IVERED,
Name of Property Owner. T
Address of Property,
Agent's Name
or Road, City & County)
I hereby certify that I town 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 prc,posing, e cription or, f—I wit dimensions,rr�ust k� t���a�red d with this Ieiter.
w I, -_. I have no objections to this proposal,
proposal,
I have objections to this
If you have objections to what is being proposed, you must notify the Division of Crustal
Management (©CM) in writing within 10 days of receipt of this notice, Correspondence should be
mailed to 401 S. Grim St., Ste 300, Elizabeth City, NC, 27909, DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified b Crt'tthed Mail..
WAIVER SECTION
I understand that a pier, dock, mooting pilings, boat ramp, breakwater, boathouse, lift, or groin
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 sign the appropriate blank below,)
I do wisp to waive the 15' setback requirement.
I do not wish to waive the 15` setback requirement.
(Property Owner Information)
.. r,'_ >'
V*n ture
Print or Type 149me
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(Adjacent Pr9perty Owner Information)
(.�
print or Type Norris .............._
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