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,6AMA / DREDGE & FILL iY lj`t 7 A 8 D GENERAL PERMIT Previous permit# w4f�lew Modification Complete Reissue --.;Partial Reissue Date previous permit Issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC f N;}j,Jo/{tJ ' , les attached Applicant Name _ t� f�✓ t o Project Location: County C< r 1 z r e T Address /4TTN �w" 4� Street Addret Stet Road/ Lot #(s) NC /O a2 �tGJ Ji�X,<.r-o;-r..Ji-t,.,.30,{' dr a.of'R114!(Tws! (jrr`o✓4 CityState,, ZIP 1b'1ii { N-- Phone #J7_1 t 9"ef71` ,•khr�-.� S 3) 8r E-Mall Jdyr°„�-r-� y, jam. ry Subdivision y e-Idn Irk%twrt 67A JQ`ra a ,�, tr f7 C., slia�rt Authorized Agent J —.._.. _ Clty_-. . ,.... L _ ZIP ,W6W .IEW KVTA LY6 OPTS Phone# Affected ( ) LL _ .___ River Basin -:!OEA i1HHF �'IH ❑USA CWA IpxC.tee.k AEC(s): Adj. War. Body — _ nat /man n Pws:rid r e. C...i^a cat-C- Z' w of ORW: yes ! PNA n if Closest Mai. Wtr. Body _.. _ Type of Project/ Activit) 4r ^ts If^tAr r ter `/ ✓c C'" 'Ndef flaif t. r.c4 VI' JJ!'Qc'f✓a )go I2. (Scale: Pier (dock) tength_�_„�, _. Fixed Platforms) ... w' e„..m . Floating Pladorm(s) Finger pier(s),._.._.._ Groin length ... ... . ...... __.. ._. number._ Bulkhead/ Rip r ip length.. ..- _. I 1 �4 t Ct f G� C C C f avg distance afishore : i / maxdistanceoHshore '.. _... _....... _... '. Basin, channel .------ cubic lards „j, R t O rfc Y- ps;,+' iM I Boat ramp _--------- .. :. ... :.._ ,.. .... _..._ j. ....... _� Boathouse/ Boatbn Beach Bulidozinf Other Shoreline Length SAv: not sure yes ... '.. r .... Moratorium: n/a yes ro Photos: no Waiver Attached: yea no - ,. -.... I _ . -------------:._.... C I ..�:.._..c... . _ _.. _... _: a A building permit may be required by: See note on back regarding River Basin rules. I Note Local Planning jurisdiction) 6 ���" r`'` r4r'�f e j e,-�'f" 'i-a f.c/'rrr:) ^ rt'QJ'" ° ^ f'^"�t °" a ni J o ✓ ! < ;, Notes/ Special Conditions ►jt A ea. WS'}}, el. 041 f'jnir 4grc.ftkr l'%w�j ai. Px. .rr.e 4. jr"2—.l';7JC7 ,4 '14- 10PX4 ,,,a'F`{. vx.7'n iGtb l7 ry4.e!'-Y✓rr �q��F r"8e^t m �PPIi�>teame`3"`_._.-. ._ ................ .__.. ature s r .compliant®statwme'm on backot permit" Application Feels) Check # yro frnJ'ce<r r,, rsi»err..+ / L Me PennnO(Bcer's Printed Name Signature —7y-1grlA Issuing Date Expiration Dace ®21CAMA / L96REDGE & FILL t NLO 70433 A B ® D GENERAL PERMIT Previous permit# �ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC NA4/or�J, C ulers atred. Applicant Name C,A 1 1 Grfa' Project Location: County Address #yw /liar �" �% Street Addres¢/ State Road/ Lot #(s) N ®� cz �161—rA-�F` •r -o�' ,Tf^�2t+e�' f^pi Alat'rJt o�rRtlGl(•Tuv e (,N�o✓a P'J f r NL �211 I• City C1.«rlo'I State ZIP 1 _ Phone # (�?�) (� �9 Ol7l- E-Mail `.trua. saw.. c• Subi Authorized Agent T"J'0 n 16t&rk "v r d lo f� }• r City Affected &6W ❑EW R TA 94 ❑PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ElUSA ❑ N/A ❑ PWS: ORW: yes / no PNA es / no geav7S %•t i N � ZIP J c Oa (_) River Basin I l� Adj. Wtr. Body � zICr.e�nat man n Closest Maj. Wtr. Body ',a - Phone # ME MEMMEM ■■■■■■■■<1■Gib■■■■■■. 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Agent or Applicant Printed Name Signature ** Please read compliance statement onbackofper it** Application Fee(s) Check # Permit Officer's Printed Named t� Signature Issuing Date Expiration Date vata Watt 1001 1000 C Solt, tionsI June 6, 2018 1638 Clyde Fitzgerald Road Linumd, NC 27299 (336)237-9393 Fax (336) 237-9394 North Carolina General Contractor License #44601 NCDEQ — Coastal Management Attn: Stephen Lane 400 Commerce Avenue Morehead City, NC 28557 Dear Sir: RECEIVED JUN 2 9 2018 4DCM-MHD CITY Attached is a completed CAMA Major permit application package for DataWatt Solutions, Inc. to install a permanent repair fiber optic cable on behalf of Conterra Networks. The project will cover approximately 455 feet around the intersection of NC Highway 101 and SR-1161 (Tuttles Grove Road). DataWatt Solutions will be placing a new 1.25" conduit containing a fiber optic cable. A bore pit will be dug on each end of the bore to tie into the existing Conterra conduit pathway. The adjacent riparian owner's notifications are included. We received one response back. The other came back undeliverable. If the attached plans are satisfactory, please return the approved permit to the attention of: Conterra Networks ATTN: Marty Pulley 2101 Rexford Road, Suite 200E Charlotte, NC 28211 Should there be any questions concerning this request, please contact me at 336-689-0675 O F /_ . DataWatt Solutions, Inc. 1638 Clyde Fitzgerald Road Linwood, NC 27299 Phone (336)237-9393 Fax (336)237-9394 Cell (336) 689-0675 iason. bu rkhartCa.data-watt. com Attachments DomMra RECEIVED APPLICATION for JUN 2 9 2018 Major Development Permit DCM-MHD CITY (last revised 12127/06) North Carolina DIVISION OF COASTAL MANAGEMENT 1. Primary Applicant/ LandownerInformation Business Name Project Name (if applicable) Conterra Networks Applicant 1: First Name MI Last Name Marty T Pulley Applicant 2: First Name MI Last Name Brian Widmer If additional applicants, please attach an additional page(s) with names listed. Mailing Address PO Box I City State 2101 Rexford Road, Suite 200E Charlotte NC ZIP Country Phone No. FAX No. 28211 USA 980 250 2389 ext. - - SlreelAddress(ifdifferent from above) City Slate ZIP Email mpulley@conterra.com 2. Agent/ContractorInformation Business Name DataWatt Solutions, Inc. Agent/ Contractor 1: First Name MI Last Name Jason A Burkhart Agent/ Contractor 2: First Name MI Last Name Martin A Burkhart Mailing Address PO Box I city State 1638 Clyde Fitzgerald Road Linwood NC ZIP Phone No. 1 Phone No. 2 27299 336 - 237 - 9393 ext. - - ext. FAX No. Contractor # 336-237-9394 NC - 44601 Street Address (if different from above) City State ZIP Email lason.burkhart@data-watt.com <Form continues on back> 252.80B-2808 .. 1-888-11RCOASI .. www.ncr.oastalmanagcrriont.net Form DCM MP-1 (Page 2 of 4) RECEIVED APPLICATION for JUN 2 9 Z018 Major Development Permit 3. Project Location DCM- Counly (can be multiple) Street Address State Rd. # Carteret 1989 NC Highway 101 NC HWY 101 Subdivision Name City State Zip Beaufort NC 28616 Phone No. Lot No.(s) (if many, attach additional page with list) - - ext. 6176 , 6872 , I , a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project White Oak River Bell Creek c. Is the water body identified in (b) above, natural or manmade? d. Name the closest major water body to the proposed project site. 1XINatural ❑Manmade ❑Unknown Newport River e. Is proposed work within city limits or planning jurisdiction? f. If applicable, list the planning jurisdiction or city limit the proposed []Yes [DNo work falls within. 4. Site Description a. Total length of shoreline on the tract (ft.) b. Size of entire tract (sq.ft.) >100, NIA c. Size of individual lot(s) d. Approximate elevation of tract above NHW (normal high water) or N W L (normal water level) (If many lot sizes, please attach additional page with a list) S ®NHW or ❑NWL e. Vegetation on tract Grasses f. Man-made features and uses now on tract Roads and Culverts g. Identify and describe the existing land uses adjacent to the proposed project site. Residential Dwellings, Church h. How does local government zone the tract? i. Is the proposed project consistent with the applicable zoning? NIA (Attach zoning compliance certificate, if applicable) - []Yes [:]No ONA j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No k. Has a professional archaeological assessment been done for the tract? If yes, attach a copy. [-]Yes ❑No ®NA If yes, by whom? I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No ❑NA National Register listed or eligible property? <Form continues on next page> 252-808-2808 .. 1-888-4RCOAST .. www.nccoastalmanagement-net RECEIVED Form DCM MP-1 (Page 3 of 4) APPLICATION for JUN 2 9 2018 Major Development Permit nrnA_KANn rITY m. (1) Are there wetlands on the site? ®Yes ❑No (it) Are there coastal wetlands on the site? ©Yes ❑No (iii) If yes to either (i) or (ii) above, has a delineation been conducted? ❑Yes ®No (Attach documentation, if available) n. Describe existing wastewater treatment facilities. NIA o. Describe existing drinking water supply source. NIA p. Describe existing storm water management or treatment systems. N/A 5. Activities and Impacts a. Will the project be for commercial, public, or private use? ®Commercial ❑Public/Government ❑Private/Community b. Give a brief description of purpose, use, and daily operations of the project when complete. Replacing damaged Conterra duct and fiber optic cable c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type of equipment and where it is to be stored. Duct will be placed via horizontal directional drilling. Only one horizontal directional drill will be required for the placement on this duct. d. List all development activities you propose. Only replacing the single bad section of conduit for a total of approximately 400' e. Are the proposed activities maintenance of an existing project, new work, or both? maintenance of existing infrastructure f. What is the approximate total disturbed land area resulting from the proposed project? ❑Sq.Ft or ❑Acres 400 linear feet of HDD, and 100 sq ft of bore pits located on shoulder g. Will the proposed project encroach on any public easement, public accessway or other area x❑Yes ❑No ❑NA NCDOT RIW that the. public has established use of? h. Describe location and type of existing and proposed discharges to waters of the state. There will be no discharges into any water systems I. Will wastewater or slormwater be discharged into a wetland? ❑Yes ❑x No ❑NA If yes, will this discharged water be of the same salinity as the receiving water? ❑Yes ❑No ❑NA j. Is there any mitigation proposed? ®Yes ❑No ❑NA If yes, attach a mitigation proposal. <Form continues on back> 252-808-2808 .. 1-888-4RCOASI' -. www.nccoastaluianagernent.oct RECEIVED Form DCM MP-1 (Page 4 of 4) APPLICATION for JUN 292019 Major Development Permit 6. Additional Information pCh.44AHn CITY In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted In order for the application package to be complete. Items (a) — (I) are always applicable to any major development application. Please consult the application instruction booklet on how to properly prepare the required items below. a. A project narrative. b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish between work completed and proposed. c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site. d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties. e. The appropriate application fee. Check or money order made payable to DENR. f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in which to submit comments on the proposed project to the Division of Coastal Management. Name Tuttles Grove United Methodist Church Phone No. 252-838-0070 Address 1989 NC Highway 101, Beaufort, NC 28516 Name Charles McKay Phone No. Address 4810 NW Highway 172, Lot 123, Arcadia, FL 34266 Name Phone No. Address g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates. h. Signed consultant or agent authorization form, if applicable. i. Wetland delineation, if necessary. j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner) k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act. 1 7. Certification and Permission to Enter on Land I I understand that any permit issued in response to this application will allow only the development described in the application. The project will be subject to the conditions and restrictions contained in the permit. I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up monitoring of the project. I further certify that the information provided in this application is truthful to the best of my knowledge. Date (�d %/G(o /:7 Print Name Signature Please indicate application attachments pertaining to your proposed project. ❑DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges and Culverts ❑DCM MP-3 Upland Development ❑DCM MP-4 Structures Information 252-008-2608 .. 1-008.,IRCOAST .. www.necoastalmana0eurent.net A �I' __ 'I b I R M NETWORKS Fiber (given. People Powered. RECEIVED May 29, 2018 RE: Letter of Agency Designating DataWatt Solutions, Inc. JUN 2 9 2018 DCM-MHD CITY By this letter, we hereby authorize DATAWATT SOLUTIONS, INC headquartered at 1638 Clyde Fitzgerald Road, Linwood, North Carolina to act on behalf of CONTERRA ULTRA BROADBAND HOLDINGS, INCORPORATED and BROADPLEX, LLC (a wholly owned subsidiary of Conterra Ultra Broadband Holdings) in easement and right-of-way requests, permit filings, route planning services, CAMA Permits and other matters related to the implementation of telecommunications projects. Authorized Signatories for Data Watt Solutions: • Martin Burkhart —President • Jim Brogden—Vice President • Jason Burkhart—V.P. of Compliance and Support Please feel free to contact me if you have any questions or require any additional information concerning this authorization. Very Truly Yours, A David Warden VP Fiber Development and Deployment Conterra Networks 0 Q Q d � � W RECEIVED ` ~ N y LL O � W z .FM C, Q L u O O JUN 292018 R�3:� v�z� DCM-MHD CITY 00 Q LLJ Lu C w LLJ m mQo o Lu � zb= 000E�Q 'I- w Lu I� zm*k U� Op U z U zH ^ w Cn Lu r-1 Z O w � � p � LLJ LL_ �U w m m U Q H w zi� :�i LLJ Y O U < m Q w � mLO LL Lu L U Lu o O U RECEIVED 2N29m8DCM- MHD CITY 15) §} §\ / �`! & e - ° t 00 »� © n k; \ MS ^~ \/ o\/ t / E / !m k , \/ 0 m �� ` o e m § � | �. � . | § § ±(! . )R |� § RECEIVED B| d;292018 �,- ■d| OCR UHO CITY 2 | �\ Ld 2 \LLI Ld j\\k�r \ \ /} \ (2jE\} § -! } } j§7\/ \ (\ e o,���L m » °§� % 2 gig, \ e \ § \C)/ �k( \\F } oez \ sR/Lu . | m \ § \ ( § : - \\ _ § � �� ■ k �k ! } § z � k §|.lb 9` 2§■ �< _. § .aB �§ :;§§ § ■ ®;!|!,| ! | m|�° |!®�- §§!! � � |�;:! § � � RECEIVED rN; JUN 2 92018 |/ DCM MHD CITY d § (\ § § 2\ § | o m - - - /\ K« � \u k(< ww LL \/ ry cc| \\ a ao m g § ( j - d » - ® | ( § Iq j J k t w [ & k§ §.!§.o m j\ w� ZM | | § !)E .a; |!!§ |�,�a W o° o a m� LL0 w Sim p �Z U Q NK W° a N w m ` W S Z_X. wJi FK �N Q W WO JOW 6w ° p2€O yW� > xZO t2"WauFttWm�W°~D33 aaJ m� ] a o zt�tBE_ sapLLaLLWg�No�ZCy yu 2Wrc 3WW1Z 0 2 NRECEIVED O z d 0-0 m°Uti-rcN = =NWU2 a{'L ioFo rc szW 55R sz Zz o mmWQa wNZarco 6Fu u aaU �pY_f0wGW„ wZT°��wzmw�a .oH mUo INou°p6-t WaHB voNow 2 9 p aaZpoz aZ o FJlN SU N� Vm� rc�w0mza Ww m- a w=$ g_ � w w= °CM-MHDCI WKaNw0V'J�]LLZ' °J�5 1NNFWNVF 2,z pFmyz°1uiFU_ma 9FZa �Uwa mU� 7wruW>°F R°o�aO¢3 w FQ N]W ]2 OZw G1J1 NFZ p poW 2o ym 0' .,o z0W2 0 ;8, dgSm LLW 60z 0 00 WLL ooU ooz Ow u 2x8 zz z °Jo� w > aa° Fo �uu w ]Nz Wu oz z =m a LLJ � 5p95�3E�3 QGuSS �;Jj, E Z. €=aZ ¢0 w Z W r OF Wmior aWN� g= ° WpW° NZ QF9 N >Zy 6W �yW Z �pppy OO N Z N�ziwuo xa m °u°i $0 W. a w= 65mz �33yFz zowaKYKo°>>->U LwNJaWu9w�zoW a°gpQpWon wJa�i �o°iirarcop a 2p =wYK �wa6NaFf68aab�r. omWK �Oar�WrW0UW�9 mFY �qq52UQrc'�WJaGWm WgKY7UNG aW > Fopwa�NµCJZvLLmI �<m F23 � zu o°O go ° > rN wi w�rO Q �WF°° ¢NNOI2! O o m Fo X, °o Zw W u ap a� q OJOY Oz Q°LLiv: ¢ZmWULL y W a]OJW F3 Z O W OOQ W m.iw%O p W W ON J 2j O20 ,m Up '0w < _ Z6O�6 u �p$ Oa O¢2K < z UZZO Uj O W pWZF 0.Z3 ZW 0 `Qz z =FZ OQpa om= pi w u omw o o 0 H a ]_ ]=w O zawFOo zN aoQ O FF LJ Z W 0 0 wQjpw -LLm� Zd0JNm�W t wp �ZOVmUKZ0pN7Om WQK06a�UUp]aNrcu��W�' NW'SoZQK�¢�w°�Z_Z¢p`�OU' ?y W yS0��>O1 w,NUSF O F 00 ..32¢-2~ jK 6—W Z m°V Z W ¢N V-OS ° w oWKU� rc W QZz_°N O-X2a °w $ W. zOK ZOo jW OZLLOJZ ti- UUw�w QMp U<W UHWN m W Upp jt n aKwFQN `oKEqE F~ -N O p9 U NFo RO N602° p O° - °K�p =FWSF m462m OU=Fw �,ZoOl .0 4NOwW ��Z- W$ zWU zo ZS as aN 0°O F �wg°Z 911QZ N a m� o9S JO W 1U2UO Fa Z <Z9MW rO0�] mO m N o Z. JZ a .@a]GJWyyU6aW'�� z0� ¢9Wz 6va u �uogu H a ' iK9m��y° YmGZpOOJ atiW� N Z, wW€ FO o Om2 0 O ¢o 02 2 WWO UwS° .Tz pO� 2 aW �F6 0 g wmU �m9Z6 r Ei \_ \ > @ �i ®® RECEIVED j/\ ±N»»am eer / .CM MHD QTy -- / \ /( § Ja ; § 3 " \ <A !! ems\ q : /)\ \ g/ wz« e & §e» / \ / }§ | \\ ¥ o , \ w e R ,t 3 z o § r| / LLI F- j §� " \ � k o 4 ) � � ■ �§ � | � ~ §| , | �{E( ,=:§f RECEIVED |§ JUN 2 ¥ 2018 - §K = Al i| DCM- MHD CITY 2 §r% fff \\k f §J0 B;k �! §! Mom {� §I ƒ { MiLL z a�°- � \ (% \/% - zG/ ■$; 77 of j � \� | LLJte m ® ---- - y � w y | � cv) --- ! CN not? | Z[c D 63 ; /\� ()$ _ |!!« |�;�� § RECEIVED {§ 2N295§ � A■| OC UHD CITY , � \} \ L e_ ems 1 > \ 0 � ° \/ z © / � » \ • |■ wLd e //\ Q / e: \ \\ / Z \ N§ r x := Z� \ > |6/ §& {$§) ; LU � © %M°w mr §§§; Byz | j§ `| '§§§§ \ Q § > ° \\Ro /} §; �© )E Y bmmN^\§ �7 0)G<0 3% O § �( ..|(k§ §/ E»Q)/ !¥ &w*! mw | w w u !). .un |k(\, |�;�� § /) RECEIVED a� e Ju N 2 » 2018 |} DCM- MHD CITY | D } \ | ey $ 5\ z I §® \ / \ ( / / /! ,§ w/01 //\ | \ \ | m / | i ± | | | | § \ ) § ; » ƒ z u z m |l,:: §� RECEIVED y 2N2955 f§§§ \§ DC MHD CITY §® §)} | 00 §! r»§ |— !! ^�� \ \ ■i \ ��| © S \/ ?,®©^^^^\\»© \0 ^4 |\E . ,�,�#$,, = / \ � ���~^^ 0 \ \ \ Z � /DZ f / _ 1�m �s % | | § § ») .f§! |�,:� 1W^ u/ 00 ~ N Z 00 Z U W 0_ 0_ U Lii ry /w� U W RECEIVED JUN 2 9 HIS DCM-MHD CITY N iO U X�� %W ILJ pOm Y Z UU Y N� X m� �p lJJ W � U / �a DZ ♦ OO O7 04 �I �m m P u- &CONNECTGIS WEB HOSTING t �f 1 All a IJI� p ____ 2.2'M - q P 7W J S tiZA I ,r, 1 : 138 Feet Printed June 27, 201 See Below for Disclaim 2018 Tax Parcels (contains 201 Centerlines NC Railroad Right of Way 13 County Boundary 11 Other County <all othervalues> Cart PIN Acreage Parcel Dimensions Lot Number RECEIVED JUN 2 g 2018 DCM-MHD CITY 000NN(—�^'^' 'r'/'� Can ECTGIS <JA4 ` Printed March 15, WEB HOSTING. l,� See Below for Disd Address Points • 2018 Tax Parcels (contains 201 Centerlines NC Railroad Right of Way 0 County Boundary 0 Other County j <aII otherealues> Cart PIN Acreage Parcel Dimensions Lot Number RECEIVED JUN 2 g 2018 DCM-MHD CITY 1 : 62 Feet f CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: NCDOT / Conterra Networks (Encroachment) near intersection of NC 101 and Tuttles Grove Road, Beaufort, NC 28516 (Lot or Street #, Street or Road, City & County) Agent's Name #: Jason Burkhart Agent's phone #: 336-237-9393 Mailing Address: 1638 Clyde Fitzgerald Road Linwood, NC 27299 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 letter. 4, I have no objections to this proposal. I have objections to this proposal. I `ou 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 information for DCM offices is available at http://www.nccoastaimanagement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST. 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, boat ramp, breakwater, boathouse or lift must be set back a minimum distance of 15' from my area of riparian access unless w ,F)A 1f you wish to waive the setback, you must initial the appropriate blank below.) N/A I do wish to waive the 15' setback requirement. JUN 2 9 2018 N/A I do not wish to waive the 15' setback requirement. CCM-MHD CITY Jason Burkhart Print or Type Name 1638 Clyde Fitzgerald Road Mailing Address Linwood, NC 27299 City/state2ip 336-237-9393 Telephone Number/Email Address 03/29/2018 (Riparian Property Owner Information) Signature Print or Type Name 1989 NC Highway 101 Mailing Address Bauefort, NC 28516 City/state/Zip 252-838-0070 Telephone Number/Email Address Date Date (Revised Aug. 2014) USPS CKING # IIIIIII�IIIII First -Class Mail IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII US Sge &Fees Paid 9590 9402 PermdNo.G-10 1752 6074 2432 83 United States • Sender: -Please print your name, address, and ZIP+q® Postal Service PATp't,'11�7 S� In this box. Ito3g� �T=arts L,Tr.lt�-TZ.CEiLAL-h Qb 1, 2, and 3. ■ Print you ■ Complet!I-- A and address on the reverse so that weturn the card to you. ■ Attach thi X to the back of the mailpiece, or on the space peo:�1�I� B, NN"Y ! Ar1--f1Cac1 t �L II fIIIIIIIIIII Io3. duN❑rd,u 959f1 o�.-,. __ E ' m or, ----------------- 7017 2400 0000 1887 7037 PS Form 38 11, July 2015 PSN 7530-02-000.9053 `J iq I, enter deliveryss belom adtlress below: JUN 2 9 2018 DCM-MHD CITh Ilgnature 'signature Restricted Delivery ❑ Priority Mail Express® p Reg�isterreedd d Mail® d Mall Restricted Delivery May Restrict ad Delivery on Delivery ry I Delivery Restricted Dell Return Receipt for ail very all Restricted❑ Dellvery Cl Sign turedConflrmatlonTM Signature Confirmation g Restricted Delivery Domestic Return