Bickett, William (2)

®�L&- MA) '❑ DREDGE & FILL NO. 75757 A B 4 % D
GENERAL PERMIT Previous permit#
MNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 'F/ / 1 f�
and the Coastal Resourc s Comm! on in an area of egv'ronme tal co nce n pursuant to I SA NCAC / /
QRGies [[ached.
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Authorized Agent
Affected CW ❑ EW ❑ PTA
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❑ PWS:
ORW: yes /(no ) PNA yes / no
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Agent or Applicant Printed Name
Signat�f ase read compliance statement on backofpermit**
/� plicati9 FAe Ks Check#

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
40
Name Of Property Owner. _104
Address of Property: V1 / T e,)TiQA Cor4S % Al, L A vE
(Lot or Street #, Street or Road, City8 Counry) !<y�Q
Qd/NIyA/G 28Srf�f
Applicant phone #: Z SL -,/ g'U 4 p Mailing Address:
(l11pg6L.,w0: ,rlLa«.G Stc1a.-P-- —
904464-10tJ 9T7 8lafrc.✓fkn�- Ra P°/er ��` ��vAQ PcystT,.t
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 descri ton o drawin wi di an ' ns in be rovided with this letter.
___-Z1 have no objections to this proposal. _ _ ( have objections to this proposal.
ff you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact irr/ormat n for DCM offices is
available at www.nccoastalmangementneticontacLdcm.htm or by cam 1 for DCM offic is
response Is considered the same as no ob/ectfon if you have be.. notlNed by Certified CO
WAIVER SECTION
minimum distance of 15' from my area ofriparianacssunleswaived
I understand that a pier, dock, mooringpilings, breakwater, boathouse,
ved bylift
me. (If you wish to a
waive the setback, you must initial the appropriate blank below.)
n//i� BUlki►tA�1 0.✓�
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
{gyp r7, roperty Owner Information)roperty Owner I formation)
mmmm���vS1g inure Id�—
R/C/,+k'b 0A(P14,+A/7
Pnnt or Type Name
/LP"GFDAO oordT B41/I3
Madmg Address
C-15DW Po is F iyc .4 Pis¢
City/stare/Zip
_ 2S2
Telephone Number
Date
Y 6. 3 ---
Signature
�1tf e, o t �
Print or Type Name
airing Address
City/Sta p �b Z 77
Te ephone�O��-
-/dl7 �I
Date--

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner.
Address of Property:
or Street #, Street or Road, City B
Applicant phone#, MallingAddress: 96/7
f."444- We 26z7
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. must be provided with this [after-
1 have no objections to this proposal. 1 hyve objections to ttds proposal.
Nyouhave objections tow'�ratfsbeingpmposed jwu'mustrro*-&Dlvlslo;�ofCoasNiManagement
MCM) In writing wNhln 10 days of rocWpt of this notice. Contact Information for DCM oNkas is
available at www.nocoosm/mongement neNcontect dcm,him or by calling 1-888.4RCOAST. No
response Is considered the some as no obhretlon If You have been nodfled by Cartitied Mail.
WAIVER SECTION
I understand that a pier, dock. mooring pilings. breakwater, boathouse, or lift must be set back a
minimum distance of 15' rf oiii myarea-afTiparlan cces u ass Waived by me. (If you wish to --
waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 16 setback requirement. ' 7 Ar- t//r✓P49-�Ull�ily�404
I do not wish to waive the 15' setback requirement.
5KG".
(Property Owner Information)
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Sil nalure
Prfnf or Type Name
96 r? fir.
Meffing Address
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Telephone Number
Date
(Riparian Property Owner information)
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nt or Type Name
l07 �i-rfirtxGoc�Sta�Cou�t
Mailing Address
rg 1,106;,,7- NC a 95
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Telephone Number
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Date

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