17557D - Farrell

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CAMA AND DREDGE AND FILL 01 �_
GENERAL
-1�
PERMIT
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 7W +/1 of
Applicant Name 1%kti 5. /' RR
4e II 7 PA (3`4R>r Phone Number`4,�� �.)373
Address 513 9 6,P-f4/4.1)e z Q°p Rd
CityIN: v e ?d107
��"D State N Zip
Project Location ( ounty,State Road, Water Body, etc.) 'r 9 a1 6it-F4(N/1 e 10°P /fii . Add
i drt /Mit itiAA, tikt ov°A / .
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Type of Project Activity FP— .t4 9 4 67 j A
o". O 4 riq'`f p cf tPJi?u 61 6 y ,hirr c 4
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kH LONd,47.,A‘ Ut 7/1 , IJov Sgfri, A/)1°iY
PROJECT DESCRIPTION SKETCH (SCALE: / /1 - /
5 )
Pier(dock) length 1 I/ X I' -....,..--------- tilek, (la -8 K ....----......—
PI
Groin length— — 0J VI
p<it
number I 4
Bulkhead length
V
max.distance offshore V ,
V
Basin,channel dimensions 1
411 X bl P.Cr-
cubic yards , 4 ,
NAi
Boat ramp dimensions ,
Other T—/44O /QiX/h/.
1/0/17" g Y/6 ' '''/ ;,
); V
z%
/75' tot .3131 bta-,,die
This permit is subject to compliance with this application, site 1/
drawing and attached general and specific conditions. Any AC l
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be- r applicant's signature
come null and void.
?1,4A lierelpe,_
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- f~/6-9S— (F--/k` y1r
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no 7 Al /,0(J
attachments
objections to the proposed work.

c' SENDER:
0 ■Complete items 1 and/or 2 for additional services. I also wish to receive the
fii ■Complete items 3,4a,and 4b. following services(for an
92 ■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you.
j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
2 permit.
y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery
« •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee.
0
-0 3.Article Addressed to: 4a.Article Number 7
a Mr. & Mrs. Bill Gage .3 -2— �J�
E 6046 Leeward Lane 4b.Service Type
o n Wilmington, NC 28409 0 Registered �XCertified
co 0 Express Mail 0 Insured
o0 Return Receipt for Merchandise 0 COD
Q 7. Date of Delivery
z //) '!
/
E 5.Received B :(Print Name 8.Addressee's Address(Only if requested
w and fee is paid)
g 6.Signs y.(Add '.*, •ge
PS Form 3811, December 1994 102595-97-8-0179 Domestic Return Receipt

UNITED STATES POSTAL SERVICE First-Class Mail
1111 Postage&Fees Paid
USPS
Permit No.G-10
• Print your name, address, and ZIP Code in this box •
John S. Farrell
5938 Greenville Loop Road
Wilmington, NC 23409

��� DEPARTMENT OF THE ARMY '�,
as � i WILMINGTON DISTRICT,CORPS OF ENGINEERS
w M P.O.BOX1890 50
I,
WILMINGTON,NORTH CAROLINA 28402-1890
4, su�� REPLY TO
ATTENTION OF
April 14, 1995
Regulatory Branch
Action ID No. 199502250 and General Permit No. 197800056
Mr. John Farrell
c/o Boat-Lifts and Marine
Construction, Incorporated
Post Office Box 5365
Wilmington, North Carolina 28403
Dear Mr. Farrell:
Through coordination with Ms. Ann S. Hines of New Hanover County
Inspections Services, we have learned of your plans to construct a pier on
Hewlett's Creek, Wilmington, New Hanover County, North Carolina.
On January 1, 1994, we renewed general permit No. 197800056, (copy
enclosed) that authorizes the maintenance, repair, construction, and
installation of piers, docks, boathouses, boatshelters, mooring pilings,
dolphins and jetties in navigable waters of the United States in the State of
North Carolina.
Your proposed work is authorized if you can comply with all general
permit conditions. Please read the enclosed permit to prevent an
unintentional violation of Federal law.
If you have questions, contact Mr. Jeff Richter, Wilmington Field Office,
Regulatory Branch, telephone (910) 251-4636.
Sincerely,
G. Wayne Wright
Chief, Regulatory Branch
Enclosure
n

,.
NEW HANOVER COUNTY
.0pNOV Eft 0o INSPECTIONS SERVICES
.Z ram.
.A a" +.:*�, * COUNTY ADMINISTRATION BUILDING ANNEX
�. ;gip a 414 Chestnut street, Room 203
9 '"° 02 Wilmington, North Carolina 28401
�'.NORTNC'P Phone [phone]
Zoning Division
March 23 , 1995
Mr. John Farrell
c/o Boat-Lifts and Marine Construction, Inc.
P.O. Box 5365
Wilmington, N.C. 28403
RE: CAMA Residential Pier Exemption
5938 Greenville Loop Road
Dear Mr. Farrell:
I have reviewed the plans submitted by you for the construction
of a pier located at the above referenced lot located on
Hewlett ' s Creek. Provided that all work be done in accordance
with the plans submitted and the CAMA guidelines, it has been
determined that the construction of the pier is exempt under the
CAMA Minor Permit Requirements.
Please keep in mind the construction requirements subject to this
action. Namely, the pier must not be closer than 15 feet from
the property' s riparian corridor except as specifically waived;
a T-section and/or floating dock must not be over 500 square feet
in area, the pier must not extend past the four foot mean low
water contour line nor have a total length of 200 feet or more as
measured from mean high water line, must not interfere with
established navigation rights of other users of the water body,
must not extend beyond the established pier length along the same
shoreline, and in no case extend more than one-third of the width
of the water body. Also, a building permit will be required.
This office must be notified upon completion of the pier
construction.
This letter of exemption is valid for a period of ninety ( 90 )
days only. A new application will need to be submitted if
construction is not commenced within that period.
If I can be of further assistance in this matter, please feel
free to contact me at this office.
Sincerely,[
Ann S. Hines
Local CAMA Officer, New Hanover County
cc: Janet Russell, N.C. Division of Coastal Management
Jeff Richter, Corps of Engineers

4loov RCp • NEW HANOVER COUNTY
oV INSPECTIONS DEPARTMENT
ifCif NOW C''59 3 sr 4!
COUNTY OFFICE BLDG.ANNEX
414 CHESTNUT STREET PHONE[phone]
WILMINGTON,NC 28401 FAX[phone]

BUILDING PERMIT
ER COUNTY 554 ((
DATE ISSUED PERMIT NO.
OWNER CONTRACTOR
LOCATION OF WORK PHONE#
DESCRIPTION OF WORK (Erect,Alter,Enlarge,Repair, Demolish,Relocate,Mobile Home)
NOTICE:
THE OWNER OR AGENT LISTED ABOVE IS HEREBY ISSUED A PERMIT FOR THE DESCRIBED WORK IN ACCORDANCE
WITH ORDINANCES GOVERNING SAME,AND IN ACCORDANCE WITH THE NORTH CAROLINA STATE BUILDING CODE.
NORTH CAROLINA GENERAL STATUTES153A-363, 160A-423; G.S.143-139(A), REQUIRES THAT A CERTIFICATE OF
COMPLIANCE/OCCUPANCY MUST BE ISSUED BY THE BUILDING INSPECTOR PRIOR TOOCCUPANCYOF DWELLING OR
BUILDING.
NIN}41°115
NOTICE:
THE BUILDING INSPECTOR MUST APPROVE ALL FOUNDATIONS, FOOTINGS,AND SLABS PRIOR TO POURING CON-
CRETE. FORMS AND REINFORCING MATERIALS MUST BE IN PLACE AT THE TIME OF INSPECTION. THE BUILDING
INSPECTOR MUST APPROVE ALL FRAMING PRIOR TO CONCEALING. (A 24 HOUR NOTICE IS REQUIRED FOR RE-
QUESTED INSPECTIONS.) PLEASE CALL FOR CANCELLATION OF INSPECTION REQUEST. PHONE [phone]. FLOOR
FRAMING INSPECTION IS DONE PRIOR TO INSTALLING SUBFLOOR.WALLSHEATHING MAY NOT BE CONCEALED PRIOR
TO INSPECTION. MASONRY FIREPLACE MUST BE INSPECTED PRIOR TO PROCEEDING BEYOND DAMPER HEIGHT.
THIS CARD MUST BE POSTED IN A PROMINENT,CONSPICUOUS PLACE AT THE WORK SITE VISIBLE FROM THE ROAD,
THIS CARD MAY NOT BE REMOVED UNTIL ALL FINAL INSPECTIONS HAVE BEEN MADE. PROTECT CARD FROM
WEATHER.
MANDATORY BUILDING INSPECTIONS RECORD
Zoning/Setbacks Wall Sheathing
Footing Pre-Fab Fireplace
Slab/Concrete Fireplace Masonry
Framing Floor/Piers Worker Restroom
General Framing Mobile Home Anchorage
Insulation Final

IFIED MAIL
, ,, 'RN RECEIPT REQUESTED
I Date r—s r`�5�
I
•
iJ
',11
i 11'
This letter is to notify you as an adjacent riparian landowner of
!� rt, J`SKI/'mil/
III plan to construct
on their property, J�-%6
4 "z �',�' .6' in G�//,�h,,t j�v- /l�� ,7�The sketch on the
! t 1se side accurately depicts the proposed construction.
, Should you have no objections to this proposal , please check the
-ment below, sign and ate- the blanks below the statement and
�n this letter to : 171 ‘ 5 ,.� /I, —!
f j , as soon as possible .
Should you have objections to this proposal , please send your
en comments to NC Division of Coastal Management , 7225 Wrightsville
Wilmington , NC 28403 . Written comments must be received within 10
of receipt of this notice .
•
e to respond to either method within 10 days will be interpreted
objection .
I
Sincerely,
I have no objection to the project as presently
ed and hereby waive that right of objection
J as provided
in Ge
neral era 1
e 113-229 .
I have objections to prof
4 pre.en 1
-ed and have enclosed comments • ,/ 1l
e %
Signature
Date

1,
I
; ERTIFIED MAIL
i
'ETURN RECEIPT REQUESTED
!' i Date _ ;`' (5
II II'
Il i eareiZQifiic ��
' This letter is to notify you as a
ii n adjacent riparian landowner of
/IDS. /
:_: , 1' `� �� • Plan to construct
'G:c.,jG(' i C 1y .
i�, �4� ,- � , �d on their property, .>'�/ >J
in rlatr(2,4Ly,� The sketch on the - �b-
verse side accurately depicts the proposed construction.
Should you have no objectionsto this
proposal , please check the
atement below, sign and date the blanks below the statement and
t rn this letter to: ;r/_4 • <s4./e (`a-r>1 -G
Should as soon as possible .
you have objections to this proposal;
please our
itten comments to NC Division of Coastal Management, 7225ndright ,
' - Wilmington, Wrightsville
• , S NC 28403. Written comments must be received within 10
' , s of receipt of this notice.
' lue to respond to either 'method .within 10 days will be inter
no objection. pre ec3
ti,
Sincere
--- ;21/
•
/ ? .
I have no objection to the
project as presently
Ii 1•osed and hereby waive that right of objection as provided in General
ute 113-229 .
1
I have. objections to the project as
•osed and have enclosed comments 2 presently
. J /
Signature
11 d

I
-2-
Copies Furnished (without enclosure) :
Mr. John Parker
Division of Coastal Management
North Carolina Department of
Environment, Health and
Natural Resources
Post Office Box 27687
Raleigh, North Carolina 27611-7687
Mr. C. Robert Stroud, Jr.
Wilmington Regional Office
North Carolina Division of
Coastal Management
127 Cardinal Drive Extension
Wilmington, North Carolina 28405-3845
Ms. Ann S. Hines
New Hanover County Inspection Services
414 Chestnut Street, Room 203
Wilmington, North Carolina 28401

•
DEPARTMENT OF THE ARMY
Wilmington District, Corps of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
General Permit No. 197800056
Name of Permittee: General Public
Effective Date: January 1, 1994
Expiration Date: December 31, 1999
DEPARTMENT OF THE ARMY
GENERAL PERMIT
A general permit to perform work in or affecting navigable waters of the
United States and waters of the United States, upon recommendation of the
Chief of Engineers, pursuant to Section 10 of the Rivers and Harbors Act of
March 3, 1899 (33 U.S.C. 403) , is hereby modified and renewed by authority of
the Secretary of the Army by
District Engineer
U.S. Army Engineer District, Wilmington
Corps of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
TO MAINTAIN, REPAIR, CONSTRUCT AND INSTALL PIERS, DOCKS, BOATHOUSES AND
BOATSHELTERS, MOORING PILES, DOLPHINS, UNITIES AND BREAKWATER STRUCTURES IN
NAVIGABLE WATERS OF THE UNITED STATES IN THE STATE OF NORTH CAROLINA.
1. Special Conditions.
a. Structures authorized by this general permit are piers, docks,
boathouses, boatshelters, mooring piles, dolphins, jetties and breakwater
structures conforming to the standards contained herein. The piers, docks,
boathouses and boatshelters will be pile-supported or floating structures.
Mooring piles, dolphins, jetties and breakwater structures may be constructed
of wood, metal or precast concrete. Breakwater structures will be designed to
provide for adequate water circulation landward of the structures. Other
construction activities, including excavation or the discharge of excavated or
fill material, are not authorized by this general permit.
b. This general permit does not authorize any structure closer than 85
feet to the near bottom edge of the Federally maintained, 90-foot-wide channel
of the Atlantic Intracoastal Waterway (AIWW) .
c. This general permit does not authorize construction across or into
any natural or manmade channel or waterbody so as to adversely affect
navigation by the general public. No structure may be placed within 15 feet
of a property line extended perpendicular to a channel without the concurrence
of the adjoining property owner.
d. Piers, docks, boathouses, boatshelters and mooring piles authorized
by this general permit may be extended or be located up to 400 feet waterward
of the mean high water (MHW) elevation contour or to the minus 4-foot mean low
water (MLW) elevation contour, whichever is closer to shore (distance/depth in
relation to the normal water level (NWL) elevation contour in non-tidal
areas) . The width of a pier will not exceed 6 feet, and adjoining boathouses,

-2-
boatshelters, docks and "L" and "T" sections will not have a cumulative
maximum floor area larger than 500 square feet.
e. Wooden jetties will not extend farther than 100 feet waterward of the
MHW or the NWL elevation contours.
f. This general permit does not authorize the installation of fueling
facilities on authorized structures.
g. Decking for piers, docks, boathouses and boatshelters will
accommodate loads not less than 50 pounds per square foot.
h. Wood will be pressure-treated except in areas of boathouses or
boatshelters protected from the weather. Metal or pre-cast concrete pilings
are acceptable.
i. Metal pilings or beams well have a minimum section thickness of 3/16
inch.
j . Floating structures will be supported by material that will not
become waterlogged or sink when punctured and will be installed to provide for
fluctuations of water elevation and not break away.
k. Breakwater structures will be no longer than 500 feet. They will
have a minimum of one inch openings between standard width (6 to 12-inch)
sheathing boards and at least one, five-foot wide opening for each 100 linear
feet of structure. Breakwater structures may not be constructed so as to
prohibit access to estuarine waters or public trust areas.
1. The permittee will maintain the authorized work in good condition and
in conformance with the terms and conditions of this permit. The permittee is
not relieved of this requirement if he abandons the permitted activity without
having it transferred to a third party.
m. If the display of lights and signals on the authorized structure is
not otherwise provided for by law, such lights and signals as may be
prescribed by the U.S. Coast Guard will be installed and maintained by and at
the expense of the permitte-1.
n. It is possible that the authorized structure may be damaged by
wavewash from passing vessels. The issuance of this permit does not relieve
the permittee from taking all proper steps to ensure the integrity of the
permitted structure and the safety of moored boats. The permittee will not
hold the United States liable for any such damage.
o. This general permit does not authorize any structure or associated
facility for nonwater-related use.
p. Structures and their attendant utilities, authorized by this general
permit, located on lands subiect to an easement in favor of the United States
for the operation, maintenan a, improvement, and enlargement of the Atlantic
Intracoastal Waterway (AIWW) , will be removed at the expense of the permittee,
in the event that, in the judgment of the U.S. Army Corps of Engineers acting
on behalf of the United States, the lands are needed at any time for any
purpose within the scope of the easement. Permanent buildings will not be
constructed within the easement.

-3-
q. This general permit does not apply to structures within existing or
proposed marinas as defined by North Carolina Administrative Code, Title 15,
Subchapter 7H.0208 (b) (5) .
r. This general permit is not applicable to any work on Atlantic Ocean
beaches.
2. General Conditions.
a. There will be no unreasonable interference with navigation or the
right of the public to riparian access by the existence or use of activities
authorized by this general permit.
b. A permittee, upon receipt of written notice from the Wilmington
District Engineer of failure to comply with the terms or conditions of this
general permit, will, within 60 days, without expense to the U.S. Government,
and in such manner as the Wilmington District Engineer may direct, affect
compliance with the terms and conditions or return the worksite to a pre-work
condition.
c. The permittee must make every reasonable effort to perform the work
authorized herein in a manner so as to minimize any adverse impact on fish,
wildlife and natural environmental values.
d. The permittee must perform the work authorized herein in a manner so
as to minimize any degradation of water quality. The activity will be
conducted in such a manner as to prevent a significant increase in turbidity
outside the area of construction or construction-related discharge. Increases
such that the turbidity in the waterbody is 50 NTU's or less in all rivers not
designated as trout waters by the North Carolina Division of Environmental
Management (NCDEM) , 25 NTU's or less in all saltwater classes and in all lakes
and reservoirs, and 10 NTU's or less in trout waters, are not considered
significant.
e. The permittee will permit the Wilmington District Engineer or his
representative to make periodic inspections at any time deemed necessary in
order to assure that the activity is being performed or maintained in strict
accordance with the Special and General Conditions of this permit.
f. This general permit does not convey any rights, either in real estate
or material, or any exclusive privileges; and it does not authorize any injury
to property or invasion of rights or any infringement of Federal, State or
local laws or regulations, nor does it obviate the requirement to obtain State
or local assent required by law for the activity authorized herein. These may
include, but are not necessarily limited to, a Dredge and/or Fill Permit
(N.C.G.S. 113-229) , a Coastal Area Management Act (CAMA) Permit (N.C.G.S.
113A-118) , an Easement to Fill (N.C.G.S. 146-12) and a Water Quality
Certification pursuant to Section 401 of the Clean Water Act.
g. Authorization provided by this general permit may be either modified,
suspended or revoked in whole or in part if the Wilmington District Engineer,
acting on behalf of the Secretary of the Army, determines that such action
would be in the best public interest. Unless subject to modification,
suspension or revocation, the term of this general permit shall be five years.
Any modification, suspension or revocation of this authorization will not be
the basis for any claim for damages against the U.S. Government.

-4-
h. This general permit does not authorize the interference with any
existing or proposed Federal project and the permittee will not be entitled to
compensation for damages or injury to the structures or work authorized herein
which may be caused by or result from existing or future operations undertaken
by the United States in the public interest.
i. This general permit will not be applicable to proposed construction
when the Wilmington District Engineer determines that the proposed activity
would significantly affect the quality of the human environment and determines
that an Environmental Impact Statement (EIS) must be prepared.
j . This general permit will not be applicable to proposed construction
when the Wilmington District Engineer determines, after any necessary
investigations, that the proposed activity would adversely affect areas which
possess historic, cultural, scenic, conservation or recreational values.
Application of this exemption applies to:
(1) Rivers named in'tection 3 of the Wild and Scenic Rivers Act
(15 U.S.C. 1273) , those proposed for inclusion as provided by Sections 4 and 5
of the Act and wild, scenic and recreational rivers established by State and
local entities.
(2) Historic, cultural or archeological sites listed in or
eligible for inclusion Ln the National Register of Historic Places as defined
in the National Historic Preservation Act of 1966 and its codified
regulations, the National Historic Preservation Amendment Acts of 1980 and
1992, the Abandoned Shipwreck Act of 1987 and the Native American Graves
Protection and Repatriation Act.
(3) Sites included in or determined eligible for listing in the
National Registry of Natural Landmarks.
(4) Endangered or threatened species or habitat of such species
as determined by the Secretaries of Interior or Commerce and concerned in
accordance with the Endangered Species Act (16 U.S.C. 1531) .
k. Permittees are advised that development activities in or near a
floodway may be subject to the National Flood Insurance Program which
prohibits any development, including fill within a floodway that results in
any increase in base flood elevations.
1. At his discretion, the Wilmington District Engineer may determine
that this general permit will not be applicable to a specific construction
proposal. In such case, the procedure for ' ocessing an individual permit in
accordance with 33 CFR 325 will be avail • • e.
BY AUTHORITY OF THE SECRETARY OF THE t :
f/ ti/
Geory L. Ca g
Colorfel, Corps f 'neers
District Engineer

47.
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PRIVATE PIER EXEMPTION TION SUBMITTAL REQUIREMENTS
1 . Completed form ( furnished by this office ) including the names of the
adjacent riparian property owners and the applicant ' s signature .
2 . Two ( 2 ) copies of the plan( s ) showing the pier location, length,
width, area of the T-section and floating dock( s ) , distance to
prccer`y lines .
3 . Letters must be sent to, or signed by, the adjacent riparian
property owners . If mailed, the letters must be sent
recistered mail return receipt recuired. The letters must
state that: "a minor CAMA private Pier exemption is being applied and
favor of reply is recuested. " Plans must be included in the
mailings, the form is available from this office . All
objections must be submitted to state CAMA office ( address on
notification forms ) . This office must receive copies of the
letters and the mail receipts.

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER_ FORM
Name Of Individual Applying For Permit 0.11/K. Ic„/
Address Of Property: `j 9 se _.,/ 4;r:1/1
Gd Yl C yo 9
(Lot or Street 7, Street or Road, 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 beina proposed , please write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilminaton, 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.
Signature Date
Print Name ��
C7�HNF t
Telephcne Number With Area Code

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit:
Address Of Property: 5my
<4/
fi,:ter.c1 a4a &t or Strer�Street or Ro , City County)
(Lo ►
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.
V/ 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,
Wilminaton , 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.
()14774.t.- 62- de. /e—p2>1.-
Sign re Fate
,4.
rrl Name s-3v [Di
Telephcne Number With Area Code