SC_03-01_Bucek

Surf City/Onslow
Local Government
Issued to
I �
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area Management."
James & Denise oucek authorizingdevelopmentin Estuarine Shore
at 3077 3rd Street
as requested in the permittee's application, dated 01 / 1 0 / 0 3
03/01
Permit Number
This permit, issued on 01 / 2 3 / 0 3 . is subject to compliance with the application and site drawing (where consistent
with the permit), all applicable regulations and special conditions and notes setforth below. Any violation of theseterms may subject
nermittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
THIS PERMIT AUTHORIZES CONSTRUCTION OF A SINGLE FAMILY DWELLING
1-All proposed development and associated construction must be done in accordance with the
permitted workplat drawing as originally submitted.
2-All construction must conform to the NC Building Code requirements and all other Local, State,
and Federal regulations.
3-Any change or changes in the plans for development, construction, or land use activities will
require a re-evaluation and modification of this permit.
4-The amount of impervious surface areas shall not exceed 30% of the lot area within the 75' Area
of Environmental Concern.
5-In order to prevent sedimentation, a vegetated buffer zone must be maintained between all
disturbed areas and the adjacent waterbody or marsh.
6-Prior to initiating any land -disturbing activities, a barrier line of filter cloth, or burlap must be
installed between the land -disturbing activities, and the adjacent marsh or water areas, until such
time as the area has been properly stabilized with a vegetated cover.
7-Pursuant to 15 NCAC, Subchapter 71.0406(b), this permit may not be assigned, transferred, sold
or otherwise disposed of to a third party.
8-There will be no construction allowed within 30' (feet) of normal high water.
This permit action may be appealed by the permittee or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mit m..st cease until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
Any maintenance work or project modifications not covered
under this permit requires further written permit approval.
All work must cease when this permit expires on December
31. 2006
In issuing this permit it is agreed that this project is consistent
with the local Land Use Plan and all applicable ordinances.
This permit may not be transferred to another party without
the written approval of the Division of Coastal Management.
±_ ocalOfficer (signature)
Steve Padgett
name
PO Box 2475
ti'v i i Jid Jr Surf City, NC 284Add
45
ress
COASTAL MAPl.AG
PermiHee
(si required if special conditions above apply to permit)

;rah �� � �.
� /Seuev� Tvi+f�N �,
av/ /-%4'/� p`v T/-i �. / `�/ �ir1-mil
/f �- el TD/2f�i Gcii1-iE.� �U9- fC�
O� CGS.

A driveways shall be left in good condition or will be re -
I that all refuse, etc., resulting from building operations will
owed to accumulate during the construction period. I further
ruction period, the card that is issued with Building Permits.
_ Signature of Owner.. _ ....... /_.
Rv

041
Locality
Number
GENERAL INFORMATION
LAND OWNER
Name ` j//•1c_C eC�-�,�/Sd // �'
Address
city "TL,E�{'s�(T Lyf LGQ State /02L Zip �z Phone.7
AUTHORIZED AGENT
Name i7,Qv- RA Ld( YifIl f
Address 3 07-7 3 ,Q 1. T-'
City $ s1 q/t C, 214y State Zip-7,PYt57 Phone 37,L—9rW7
LOCATION OF PROJECT
(If not oceanfront, is waterbody natural or manmade?)
DESCRIPTION OF PROJECT - G
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard 4 Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
PROPOSED USE
✓ Residential Commerical/Industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the estuarine shoreline, or 575 feet of an
ORW shoreline, or 30 feet of the public trust shoreline._3 j2 Z low.
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING 3 n
SQUARE FOOTAGE OF SITE jg�,;�1, Q S
OTHER PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the CAMA minor
development permit. As a service we have
compiled a listing of the kinds of permits that
might be required. We suggest you check
over the list with your LPO to determine if
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment syIstem),
Burning, Electrical, Plumbing, Heating and
Air Conditioning, Insulation and Energy
Conservation, FIA Certification, Sand Dune,
Sediment Control, Subdivision Approval,
Mobile Home Park Approval, Highway
Connection, and others.
any of these apply to your project.

I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an AEC or a person authorized to act as an agent for purposes of applying for a CAMA minor development
permit, certify that the person listed as landowner on this application has a significant interest in the real
property described therein. This interest can be described as: (check one)
_ an owner or record title, Title is vested in:3WDI£S Ok'DEiu15F C ByCEI( , see Deed Book,
page t459 in the t'WV/ ,LOfn-) County RegistryDeems
_ an owner by virtue of inheritance. Applicant is an heir to the estate
probate was in County.
_ if other interest, such as written contact or lease, explain below or use a separate sheet and attach to this
application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
(Name) (Address)
��ll�lll.�ilCc= :�Yi�TiL��r:G1/1�1�0� /�1 — sue•
� a
i T ;
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and floodproofing techniques.
TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This application includes: general information (this form), a site drawing as described on the back of this application,
the ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality,
and any information as may be provided orally by the applicant. The details of the application as described by these
sources are incorporated without reference in any permit which may be issued. Deviation from these details wilt "
constitute a violation of any permit. Any person developing in an AEC without permit is subject to civil, criminal
and administrative action.
This the day of nJSLd&& 20 27
2J -
Land owner or -person his agent 3iLtT
for purposes of filing a pert application.

0
AREA WITHIN 75' CAMA AEC LINE
4,272 SQ.FT.
IMP RVIO S AREA JN AQ
HOUSE = 1,055 SQ,FT.
1,055/4,272 = .2469 = 25% IMPERVIOUS
N 2elo'S2" W - 61.94' -
30' CAMA SETSAJC
�I
I�
,D
cl
inI
.h D D Ll
I
COl5'
CAMA AEC LINE
r-I
I
N
c0 b '
6
e' I
5' M.5L.
(I�' Apt p 3 ixM
JAN 2 2003
DIVISION OF
�4
C0ASTA.L NAAINAGEAIF,
DE516N 5Ei2VICE5
BUCEK PROPERTY 604 A N. NEW RIVER Dr.
3rD11 3RD. STREET SU1� CITY, NC. 26445
3UIe�CITY, RE PHONE:[phone]
FAX:[phone]
PLOT PLAN
FR'A 9/.qP GITF, . b20 1N3 NosnoJ33 £b:ZT £00Z-0T-NUE

AFFIDAVIT
OF
PUBLICATION
The Pender Chronicle
110 Courthouse Avenue
P.O. Box 726 • Burgaw, NC 28425
State of North Carolina
County 1 Pender
Personally appeared before me the under-
signed principle clerk of the above indicated
newspaper published in the City of Burgaw,
County and State aforesaid, who, being duly
sworn, says that the advertisement of
(copy attached)
appeared in the issues of said newspaper
on the ollowing day(s):
5
Subscribed and sworn to
before this day
of
A.D. �
NOTARY PUBLIC
My Commission Expires June 16, 2003
1GY"' (Principle Clerk)
CAMAI
NOTICE OF FILING OF
APPLICATION FOR CAMA
MINOR DEVELOPMENT PERMIT
Pursuant to NCCS 113.119(b). Town of
Surf City. a locality authorized to Issue
CIAMA permits in Areas of. Environmental
Concern hereby gives NOTICE that on 01-
10-03. James & Denise Bucek. applied for
'dSCAMA permit to erect.a single family
dwelling unit in theEstuarineShoreline
AEC at 3077 3rd Street. The application
may be Inspected at the address below,
Public comments received by 01-23-03 will
be considered Laker comments will be ac-
ceptedand considered up to the time of
permit decision:: Projeel modifications may
occur based on further review and com-
ments:.Nplice of the permit decision in this
matter will be provided upon written re-
quest
.Steve Padgett
Town of Surf City
r¢ PO Box 2475
214 North New luver-Dr.
Surf City. NC 28445
(910)-328-4131
2731-Jan,15..2003
JAN 2 9 2003
DIVISION OF
COASTAL MANAGEMENT

STORMWATER CONTOL CALCULATIONS:
FOR 1. OF RAINFALL IN 24 HOURS.
LOT AREA - 6212 SQ. FT.
ROOFED AREA = 1637 SO. FT.
DRIVEWAY AREA - 530 SQ. FT.
TOTAL LOT IMPERVIOUS AREA — 35%
TOTAL IMPERVIOUS AREA IN 75' AEC - 1341 SQ. FT. - 32%
(INCLUDING: HOUSE do PORCH)
VOLUME I" RAIN IN 24 HRS. ON ROOF - 1637X1/12 - 136 CU. FT.
BED VOLUME - 136 CU. FT./40R VOID SPACE IN STONE - 340 CU. FT.
BED SIZE: 2 BEDS O V(d) x 4'(w) x 45'(1) — 180 CU. FT. PER SIDE
360 CU. FT. PROVIDED 340 CU. FT. REQUIRED
DRIVE — 4" OF SLATE WITH 40% VOID SPACE
= 1. OF SPACE FOR RAIN IN 24 HOURS
_ N 28'38'52" W — 61.94'
— — — —' MOE.QE. WATER
n
ERED PORCH
v
3
ED D wewNc
jr4'
8
DRTI1
(Tp)
h 1 kill I COVERED PORCH—
DESIGN
BUCEK PROPERTY
3077 3RD. STREET
SURF CITY, NC.
STORM WATER PLAN
r
'_
..-5 45'S4 pO E
SERVICES
CAMA SETBACK
v
W �
8 �
�I q JAN 2 9 2003_..
�75CAMA AEC LINE DIVISION OF
Gc:MEN
DRAINBED SECTION
A-4'
NOT TO SCALE
B-i —4-
C-1'-6-
�ELECT FILL D-6"
A4- DIA. HOP PIPE
LINE BED WITH
[.•—.� _ , FILTER FABRIC
/157 S70NBED �'
MICHAEL C. GALLANT P.E., P.A.
604 A N. NEW RIVER Dr.
SURF CITY, NC. 28445
PHONE:[phone]
FAX: [phone]
1 "=25'
L CONN
BUCEK SWP.DWGj

TRACT DATA
T'LOOD ZONE: AF
VASL fLOOU LLLVAIION 10'
DATE 1/22/98
Wm,sATSO. FT.
5 AREA IN AEC
'rsr,-Trs�FT
1,]41/4,2IL .32 - 37 X INPFRV'fiIIS
MINIMUM
SETBACKS
FRONT --Is I
510E--7.5'
WATER-30' - .._.._
LOT 31
JANIES SLY
08 1181 PG 121
LI J ®R. M -19.]L
L2 5 45'S4'00' E 10 48
] s w 10.48
1 VICINITY MAP No scAlEI
CANAL
N 28.38'52' W
CP
ADJORIERL CONCRETE RAND
RWCNLS IA'
61.04
_ EDOE u WI N
I
u LOT 32
IOT_ BLOpt N
PG
[, �
AOIOINGS RNCF,
EMcxulLllEs 1.5
450Q.31
I
=jS
` gow+w AOIGEI lE
.• f
W
LOT 33
ARrooyp DRGaWO�
8
LLOYD BASS
^
' WW:in
{`.
d
DO 1577 PG 1048
rywW
I
POWfT: POLE ^ V'.. • iP ' ��
ONSL' IN
POWENAIPOLL AT 10'
_ J
j
� 1
�3rd STREET $ ��
FPK IN C/I. 1
3077 3r6 STREET jQ'
PHYSICAL SURVEY Pl6jm6.ImF.Z
MIS IS TO =TFY TNAT THs PROPERTY
1S_LODATEO IN A FLOOD NAURD ZONE PEA
AND SURVEY WAS
W1TN IA
LAND
7NE
X IMW
MNA
L TF.
B 1 '
1 oF1
FOUNp 1111,3111 IwC (RP) M--PIRq
D� L'OCR PO--MQ_ R�Ih�EP✓b
-m 1TW1L Y O--WIMYIm NIE �" RAO�R6R"
—vwa<AO GLOM lA[ OWC--cvnKTE 0 •
EY F010 JANES O. MCBE AND VAFE OFNNs
L S2 BLOLIE " F01fON 3
IIMSION d.D SETTLERS BEACH
x.Ow OOIJNTY STOW soumoo Tomaw
60'
Na-awulr RLIFFIO uw
BOX INS
L 10NSTON NWV.
LANDS,^PIC`A
2A &
-324-461fi

CAMA I
NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT
Pursuant to NCGS 113-119(b), Town of Surf City, a locality authorized to issue CAMA permits
in Areas of Environmental Concern hereby gives NOTICE that on 01-10-03, James & Denise
Bucek, applied for a CAMA permit to erect a single family dwelling unit in the Estuarine
Shoreline AEC at 3077 3rd Street. The application may be inspected at the address below. Public
comments received by 01-23-03 will be considered. Later comments will be accepted and
considered up to the time of permit decision. Project modifications may occur based on further
review and comments. Notice of the permit decision in this matter will be provided upon written
request.
Steve Padgett
Town of Surf City
PO Box 2475
214 North New River Dr.
Surf City, NC 28445
(910)-328-4131
Please publish on 01-15-03
J
+,� ���
r itiT
;;v�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to —�AfP Rc kc e-i- 's
(Name of Property owner)
property located at 3U uoi-
}�
(Lot, Block, Road, etc.)
on 3✓A S�fec!d-- in_ Surd CJk/ N.C.
They have described to me as shown below, the development they are proposing
at that location, and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
wv — s4or� dwc-H I dtt
� SC
Signature of Adjaad
nt Owner
Sa w,es s S 1 �
Print or Type Name
a:L �--3a'o Jr
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4 e-- 2l 0ete - •s
(Name of Property owner)
property located at
Block, Road, etc.)
on 3Yd 4reej- in tsuc; ci-N N.C.
They have described to me as shown below, the development they are proposing
at that location, and , I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Two - s-bri dwell ��z�
�� r of Adjccant Ovr.:e,
klovr' L4.A S 5
Pry or Type Name
�/0-59JL- 5 33
Telephone Number
/- -/ -
Date

Locality �(,(21 / Ol / Y
(/Yll�(Q L(1
Permit Number [� /
GENERAL INFORMATION
C 7 " 1
151
LAND OWNER �►-�
F
/�
�i jAN 4 : LL
Name �� /�is'r ¢'
�1L�i�LS
/! ��'
Address -� -
r
_
City—=%�C',kT ✓, LGQ
State
69ASTA,
Zip ;L= Phone3
] AUTHORIZED AGENT
Name t''r—,grA.41, (
Address '-307-7 3 44,
5 7`_
l City .J y B,r- C 1 1. tv
State /02—
Zip.&PgIlE Phone 3 9,&-9eAr 7
LOCATION OF PROJECT jD %T
?4 ,
sY P 4F CZ Tr,
1 (If not oceanfront, is waterbody natural or manmade?)
DESCRIPTION OF PROJECT
d
i
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard 4 Estuarine Shoreline ORW Shoreline Public Trust Shoreline _ Other
PROPOSED USE -
✓ Residential Commerical/Industrial Other
T
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the estuarine shoreline, or 575 feet of an
ORW shoreline, or 30 feet of the public trust shoreline. 3 -12 % 10W.
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING ;k-!!f 3 !2
SQUARE FOOTAGE OF SITE 4 ;2 l j , A S I.'
OTHER PERMITS MAY BE REQUIRED:
Tl}e activity you are planning may require
permits other than the CAMA minor
development permit. As a service we have
compiled a listing of the kinds of permits that
might be required. We suggest you check
over the list with your LPO to determine if
any of these apply to your project.
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
Burning, Electrical, Plumbing, Heating and
Air Conditioning, Insulation and Energy
Conservation, FIA Certification, Sand Dune,
Sediment Control, Subdivision Approval,
Mobile Home Park Approval, Highway
Connection, and others.

I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an AEC or a person authorized to act as an agent for purposes of applying for a CAMA minor development
permit, certify that the person listed as landowner on this application has a significant interest in the real
prop rty described therein. This interest can be described as: (check one)
7
_ an owner o record title, Title is vested in j6MES 0>-DENI5f G B VCEk , see Deed Book,
page $ r in the cJPySLotJ County Registry of` ffis.
_ an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contact or lease, explain below or use a sgptih$�t and attach to
application.
1
�a JV
COASTAL Mfl; : 'u" IF_NT
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
(Name)
(2>J/�WIEs i
(3)
(4)
.45A/00Pa j� St,
(Address)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and floodproofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This application includes: general information (this form), a site drawing as described on the back of this application,
the ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality,
and any information as may be provided orally by the applicant. The details of the application as described by these
sources are incorporated without reference in any permit which may be issued. Deviation from these details will
constitute a violation of any permit. Any person developing in an AEC without permit is subject to civil, criminal
and administrative action.
This the AO day of n:rad&i 20 i?X .
Land owner or -person o act as his agent
for purposes of filing a permit application.

TRACT DATA
11000 ZONE: AE
WYL . LLLVAIIUN 10'
DATE 1/22/98
}8T31cf1h.
W��r¢Rv�
PfRJs�-�Fl.
1,341/4.218 - .32 - 32 X IMPFIWnUR
MINIMUM
SETBACKS CP
FRONT--15
DF--7.8'
WATER-30' - - -^
LOT 31
JAMES SLY -
DB 1181 RG 121
s
{; 8
e
N
T5AEC 11NE
1^' M L
G
G � G
GwK STTiET
VICINITY MAP ND =CALF
CANAL
N 2WW 52• W CP Aa
81.94
C W 4
LOT 32
"'SUI;r4
w G 4M
LOT 33
LLOYD BASS
r
N NERS CGIKRM RNIP
:RMLIIE! 1.5
ENCHO ES 1�
�r
POWERCOPOLRNERE / iP �+
ON ��•R � .+� �
I \
SL' NAIL IN LZ
POWER PULL AT 1G' MSL•��
_3rd_STRE_ET
v FPK IN C/l
I
Son ma STREET ` `- — p• 30'
PHYSICAL SURVEY
60,
FLOOD CERTIMATON - - LEGEND ,o„N, I rn> ..--.D m P Nr-..NAn,M n.nIND
THIS IS TO OFR MAY D1Y PROPERTY a -D= SOS( PR FADS IP=--FDIM PR — pj
JLLOOATED IN A ROW NAUIID ZONE PFR ��` m 1061C Y ��pyry� pI1 R�-RM�1116� LPN-- i9D10 vu 1 P
COIIYINmw 370166 RANELE OIAl-OWR[AD 64DT11C MK NNC--cCMPICIL D t V. G--WWADE AIQ UIYTT No
TH6 Is TO GOUT" THAT TlA3 M.w SORYEY row. JAMES 0. eDCOC AND WFE DEMISE c. KXEK
AND SURVEY WAS DOW IN AOWRDANCE
MTH THE MACI'mcm
FOII
LAND NTFD EDT 6 32 61= " SLCIKY 3 Y SUS'
THE
nr 15 11 1 SUBGMSIdI fkA SETTLERS BEACH BWI wb
R PA Dr
STRIP SOUND 27M IDHSLON I1WY.
SLOW _ OgSITY TOWNSY' T I
PoCILAN05, NC 28T/4 //III\
12N6102 *mE 1-30'A- �20 PO S4 010-32MA616
'M FAMWO-32M3606
�� INS
� q 2003
ooII 4 o
COAS-TAL

CAMAI
NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT
Pursuant to NCGS 113-119(b), Town of Surf City, a locality authorized to issue CAMA permits
in Areas of Environmental Concern hereby gives NOTICE that on 01-10-03, James & Denise
Bucelcapplied for a CAMA permit to erect a single family dwelling unit in the Estuarine
Shoreline AEC at 3077 3'd Street. The application may be inspected at the address below. Public
comments received by 01-23-03 will be considered. Later comments will be accepted and
considered up to the time of permit decision. Project modifications may occur based on further
review and comments. Notice of the permit decision in this matter will be provided upon written
request.
Steve Padgett
Town of Surf City
PO Box 2475
214 North New River Dr.
Surf City, NC 28445
(910)-328-4131
Please publish on 01-15-03
1RN � 4 2003 �_
NjAN�E,:''
Cpp,DiR�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4,e_ Rt x el- 's
(Name of Property owner)
property located at 3U }- W
(Lot, Block, Road, etc.)
on 3rd <4(efi— ,in Su C ±, N.C.
They have described to me as shown below, the development they are proposing
at that location, and , I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
wo- sork-1 dwo-HI P't
Signature of Adjac nt Owner
Sa w,es i3 S I y
Print or Type Name
a-k�--309-")Y
Telephone Number
Date
IN
J
pIV1SION'OEnr
COASTAI- MAN

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to +' `e-- Guae--L 's
(Name of Property owner)
property located at --36T-4—
Block, Road, etc.)
on 3Yc) rye in SU4 G}y N.C.
They have described to me as shown below, the development they are proposing
at that location, and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
'rw o - i clw el 1'113
Signs r of Adjacent v.^:er,
k l o ycl 14 J3 a S S
P ' t or Type Name
D�G
l0 59� E 9 3 3
Telephone Number
- `% - 2--0 o 3
Date
2003
C� ACTAL