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HomeMy WebLinkAboutBarts, Susan 76757CIGAMA/ trBreDGE il FILL PERMIT f,Uomtrooo fc.ornpl€te Raiiroe trprrthl Rdlsuc As adrtrcd by thc Se dfrlordr CarcLr*Deneranemd Enlswrrtd Nq 76757 Prerrtxr per* Dare * ;liver Bdn ABCD Coah{cion kr an Sttt. Arfry P.lnr..lt 6lsi ApCtcrrr Cit), Phore * Audorisr&grt Pr$tct tacaOoru Corref Pttorp t A4.Wrr. MC. Wtr. zlP Aftcted AECtg): oR{/: 0cxr troca trClr 0l{f nPr BIH -es aa3 N}UA tr yel PXA )'es I I I}?cof "trlcc{Acthlty Phr(d.d.)(S.ale.I ) FiEdfie.r(r) tudr8ffinn(r) Fqglrplr{4_. 1! Cnirt ryd! fir&.r t- I e*trd al8diffiG!ft!trc. bl,|,dlrlad__ arEiE 0dr&p Borda6c/ Bodft B#r Odr.r -t ShoebE SAV ioas! F Hr&,rm ah FJ *.1 PtG: -i-!+.,i - ..: -l-i." Wri\,Er Aochcd - .*.l-- A tx{dhE Fnr&bt:Scc noeonta*n6.( Nota Lo<al Phrlinghrtdicfsr)c corr\olncls@rrErE ut 2 of3 Fcds)Chcdt*EpinrioDam 6B/2A20,6:28 PM E I i* t I hereby certiff property located at \D j so.\ gv^n S+ (Name or Propertv otnrler) ,s on *h (.'j=^N.C. has described to me, as shonn below, the development proposed at tfre above I have ro objection to this proposal. I have ot{ections to this proposal. The applicant5L DESCRIPTION AND'OR DRAWNG OF PROPOSED S-- R\+r^clreJ'|r)a*"P 5 Orner lnformation)Owner lnformation) SigrutureJl+<,*N H. Ido,&* g, 7 55n eec,7!\'ane Nunber/email affiess /ennil addlrsss4-tu-a a2A Date S ht eo$roeeg. f f, CorrA Date* (ReusedAugr 2014) P*.\*iuB C,R,erk (Address, in Pe.l e,tM{vtlaterbody) u WATVER SECNON I understand that a pier, dock, mooring pilings, boat rarnp, breakwater, bodrcuse, lift, or groin must be set back a minimum distance of 15 ftom my area of riparian access wrless waiveia by .me. (lf you wish to waive the setback, you must initial the apprdpriate blank belo,rr.)/I I do wish to waive the 15 setback requirement. I do not wish to waive the 15' setback requirement. il<car\r\ t8' o Iaa ,o -tt t oo oIt { II;i g)q o!o t3// nA'i S4uvq1 Co rnpt*tlti TA O ?,? .s b- 9.:,+o ZA d .rl r? If Dj,o ).E I\) o lI ? \ t -/'"{ADJAGENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certiff that I onm property adjacentto €uqn n, H BoB\: foperty located at loz So[eu".'+(Name of Property Orner) ,s P in . N.C.$ee- (Waterbody)g The applicant has described to me, as shorm below, the developnent proposed at the above location. I hare rrc obiection to this proposal. I have objeciions to this proposal. ) DESCRIPTION AND'OR DRAWNG OF PROPOSED DB/ELOPMENT(lnffiual poposing S."- F\!^.h-J' rn^f WAIVER SECTION I understand that a pier, fuk,mooring pilings,boat ramp, breahrater, bodpuse, lift, or groin must be set back a minimum distarrce of 15'fr,om my area of riparian access mless waived by me. (lf you wish to waive the setback,yor must initial the appropriate blank belotu.) I do wish to waive the 15 setbrck requirement. I do not wish to waive the 15' setback requirement. Ormer lnformation)(Adjacent pnoperty Onrner lnformation) tL cl(L I Sigwwe -5 u <Nn) 11 Eort * ,/i.Ctt, S+ etaplrug 14,fli urn or Address / enail ffiress IrAc"v 16 . 704 t c 7 ') 7 Tebphorc Nwber / efilaiil address .<- /t-- Date s!,ggadN@ el'['F'cor Datii - I (Revzsed Aug.2014) Print ar 8o.ttts 6-1 S"lern sh ry<\t gl t* TA Co^pteJ I o o\to t3t/9K tutlr' nAJ o a I t =_9 ,P I S)q t ,o -trf 6I!t S.utnoqg .i ??,__4 :*e {.'tk ?i3 C2 oo4. l--(A)--+ I N D3 o J z E \ tJ" ?(0t N tg)F az -(-d G t