32460_DABNEY, LISA_20020809

05/03/2004 16:10 252-444-7206 TUCKER CREEK MID SCH RAGE 02
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HY --, -20t, - FRCI 252_754_,04E 70. 24764w . 1
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ADJACENT RIFAR.L�N PROPERTY OWNER 5TAMIEi F
(FOR A PIERIMOORING PILINGSIBOAT IFTIROAT OLSE)
I hereby certify that I own property adjacent io -14 4
l / (NName of P`roperiv Qwner)
pmrvy (vatted at _ oT o?U _ C rt 'BOa..
(Lot,'' Iack, Road, etc.)
o t /0�=—in'`�
(Waterbody) (Town and/or County}
He has dc: azibed to nee, W s„twwn be;ow, tm,c developm!nt he is propu5"..r as t,ac 10CEdon,
and, I have no a' 'ec.dons to his proposal. i flierI'mo r�nE
y)musi b,- k- ,b2ck a tn1i!i rnu;n tllsLVIC! C! f'.iiE!7, IA-o!. :: ; Ifr0fi My -2
sat rpirldil access unless waived by me,
X I ) M nl wish to w'ail-I thIC setbzel requircrrenz.
wk,5 to wa21 a Cs`It sc-:beeh',
DESULPFI IOti Atip/QR DR.4,tiVLNG Or FRON)SI) DEVELOF MN-T;�...... .
(To be filled it by individual proposing dr ¢loprient)
, - , cz k*d C.ra.A,
Sigrarure
4LAt,t
Nrint or Type Na,.it
Zd't'�f1prZ �'.2iT14d.

05/03/2004 16:10 252-444-7206 TUCKER CREEK MID SCH PAGE 01
ADJACENT RWARL-�N PROPERTY OWNS . STATENT-AN `
(FOR A PIER/MOORING PILINGS/SOA711FT/80.4TNOUS1:)
I hereby =-dfr that I own property adiactnt to UScL &M& /s
L (dame of pro y Owner)
proce-y 1=& at `2�0a-i
(Lot.. dock, Road, etc.)
or w ktif 06-y- U�� .�.� in �_ _t� S Qr[� -? �._ N.C.
(W2terbody) (Town andlor County)
He has derv' ed to me; as sown below, t`a deve!opme he is prR2c�5 loCruon.�
and, I have no objections to his proposal, I unce-S:d� t1 a p:a-J moo r�nS v
piii �s;c�a lirJboathouse must be se, back a minimum distaizce of C;;jom my area
of rme,'tan access unless waived by me.
I do ont wino to wG v-, tn;, setback rz�uire rest.
I An Wish to w4vc t: at se:bacl
DESCR.IPTIO- A\-D/OR DRAWENG OF PROPOSED DEVLLQFME\T:
(To be ftl¢d i : by indiv&au l prcpnstrc; c_-.e'op,7ernc)
c:— 1�aljd �
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Print or Tyr, � •`�`�i_
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