77414_Randy Erwin_20201027

�1CS UmTe Tice 1 i5(-, xto „-•-,
Li i AMA / DREDGE & FILL D /�� I No. 77414 A C D
0 NERAL PERMIT (�, , Previous permit# NJ 4
ew _:Modification 'Complete Reissue Partial Reissue Date previous permit issued t•1 1)1,.
i a by the State of North Carolina,Department of Environmental Quality f
the / I Resources Commission in an area of environmental concern pursuant to 15A NCAC , H • 1700 / .
i L1Kules attached.
' Name )C\ Y1{ } LLY-l'o r' Project Location: County gealAct r
i
q/7 5 1 a.Ie 77 e v 9 Street Address/State Road/Lot#(s)
City . rrylijif/ state AiE ZIP T7-S SS �.;, u° rr,r()r'r=Yo1
Phone#(?5t) 31p-7--(ZZg E-Mail‘A:\'1 =r„),/+12.0'90,, ;11':. 't;� Subdivision 7a V' e0 ilt L
,7
Authorized Agent 4 - 4L C /914,tr Ir.1 (.9irr City /27/^)'I=A' r,V j! ZIP .„ 1"S 14
Affected O CW 114A ❑ES C PTS Phone # ( ) River Basin /PA 67
00EA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s):
Adj.Wtr. Body PArY)/ c:
cs Z1U'e n
El PWS: /man /unkn)
ORW yes / no PNA yes / Closest Maj.Wtr. Body Q' i1 f b 7d ve -
•
Type of Project/Activity .top k.,se c r.�4 Sittr: 1 �j , x IV 'P>e f ))-t 9t
1--- ?L'+-r ryl a- ,4 t Zj Ak t=� h ES, 64 -kk: Sale: / - 4l b' )
Pier(dock)length i A�/I 'A
1� x/ i i I ' I
Fixed Platform(s) - pr
Floating Platform(s) I I y _l M■_
Finer pier(s)s _ ry-
g P O �
Groin length I T L: I� �' Itjem.. I 1 _All— ---T— --
number ' I ' +� , i i L t
I-Bulkhead/Riprap length .■ ` ,—+ . ■ j
avg distance offshore '`; ig) . i, , I Elmax distance offshore j fl '✓ ' 'I
Basin,channel X.. '� �„
IMHNIIIIIIIIIIIII.
cubic yards I ■ MIN
Boat ramp 1 i i
; it i
Boathouse/ oatlilt J j( 13 —+. ' -y -----I
-'--
il 1
Beach Bulldozing i I I IIIIII - 1 1 I
Other . I 1111. 1l21r 1 i ■ i
;j i t♦� l i I
Shoreline Length 1 l j I K I4-0.„:, L.1.1.,- a 1 i f 4 � Y`_4SAV: not sure:" yes no '� i L
n� i
I _ _� i //i 1 .___* a `
:
Moratorium: nla yes n - ( I 1 ! . AZ --- �* ,�i
Photos: yes no i I ' 1 I _r .;4-_.__ -
`
Waiver Attached: yes no I II j i I k , 1 I
n n
A building permit may be required by: 4'0 ll y-A- "p ,t ! . y See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions •., x I 1'(a cl, iy:71l- ')•iee S.
7)
I.-- ,6 - p it' b g
Agent or Applicant-Printed Name Permit Officer's Printed
Signature Please read compliance statement on back of permit*a Si8 nature
L.. 3 - 4. ,: /t) ` . C)( t _ 20i:i1) _ R 4 7071
Application Fee(s) Check# Issuing Date Expiration Date

( ►ANe ?icy IS23`X�v' /1-c46
0 ❑CAMA/ 'I DREDGE & FILL �.. N9 77414 A &) C D
GENERAL PERMIT 14D-71 7 Previous permit# N A
,� I
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N/1
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 5A NCAC -7 Fi ' I Z00
nn�Rules attached.
R
Applicant Name Of .){� Lr k H Project Location: County 'eaLAt'cr .~r..
Address 44 i 75 Pale Pr;v 2 Street Address/State Road/Lot#(s)
City rA✓MU► ( State kJC ZIP -27-S,? 5 4-07 l? if.e c)moi4 D
Phone# (75L) 3(07--(oZZ' E-mail (a j ifu1,I)12.0 a m;11• :0" Subdivision tom 11 €o VIA)(3 S
Authorized Agent /T - w 4G.4 Mot('toe C/P1 . City 13 i/Xiiir4 f C`((' k ZIP +S 14
Affected O CW 154 114A ElES ❑PTS Phone# ( ) River Basin1k ./T Al
AEC(s): O OEA El HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body }h 4'11/
o Z I.Nit r na /man /unkn)
❑ PWS:
ORW: yes / rig PNA yes / 0Closest Maj.Wtr. Body-70 4(D 7 we,'
01 / •
Type of Project/Activity (1\ Se C or�� et/ram.. d '� 13'1 X pier W, a
l�ff%Y /r.' L '1(0U ??'+ (1)1 44t- U l3 AI?r bo.44-Ii•CA': kScale /: CID )
1y <
Pier(dock)length `'A /34 l
I
Fixed Platform(s) /� X I1' / tuo of vt-t— 1 I
Floating Platform(s) s, , , 1
Finger pier(s) I 'V�'._
I �•
.
Groin length �{ SIP
number ._ .i..._._...._._.. �—
» � f I
Bulkhead/Riprap length —.._.._�..._.. _ • --- _----- 1 1
avg distance offshore r—T~ . i'
max distance offshore frr �/q(� !�, —T (J
Basin,channel 'r� OaatI� k f
cubic yards 1 /"rer :" *►{ 1 I ! k f
I.
1
Boat rampj(
Boathouse/ oath /5- �J { I - — }
jl
{
Beach Bulldozing _..._.
Other A A AA' { • + i
1 •
�'"1141 /+- , .
Shoreline Length 1 Jc11
t..) C / i Y (�uJ1.� �1D L } 'LI�L
SAV: not sure yes no _. �+ ...! ..._ L `mot . �2Q11I.
_...
9� I J
7711
Moratorium: n/a yes ® t i
Photos: yes �.._ — ,r ','
Waiver Attached: yes .--i -;
A building permit may be required by: &AN A r 1- COUhi-/ . IYI See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) l
Notes/Special Conditions 1,04 15 bea C� kb'7. -t p'ee S.
giail
L �- 4/ey 1
Agent or hcant Printed Name Pe eI s Printed
/' ' ���
Signature **Please read compliance statement on back of permit** Signature
�J Cht• 1` 0. /U32 '3.- od+ - 7020 - 2* - re4 ZOZI
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office(9 I 0-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret, Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

❑CAMA/ ❑DREDGE & FILL N° 77414 A
GENERAL PERMIT D � 7 L49
Previous permit# ^„-I;t►'-
) C D
>� ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued IQ/0i
As authorized by the State of North Carolina,Department of Environmental Quality J
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC .7 ►'f • /700 ��
E ules attached.
r
Applicant Name v1 K"1( % , .!k, Project Location: County t-',:; ,.<4,
Address q/7 5 c:.+ii? Pr,v e Street Address/State Road/Lot#(s)
City • (m U i d( State UC ZIP S (.!.'^ t`/"r=c 0'.:4+ .-)( .
Phone# (75t) 3t 7-C'774 E-Mail . ` ,,': :',)i " i;?..C' • :fr Subdivision qirrAt r c, ?10“.), y
Authorized Agent /7 • w.t t 01 c i..# City /-7 f 1 ,*4. S l ("i.. ZIP 21 S I LF •
Affected ❑CW R Ie1 A ❑ES ❑PTS Phone# ( ) River Basin'j`jib 1 PA ro
AEC s : ❑OEA ElHHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body P YY1 / ana`t /man /unkn)
ORW: yes / no PNA yes / R�! Closest Maj.Wtr. Body-Pal(I O R 1 R/r`
i
r
Type of Project/Activity `71 a If ` ,n slt4:i i t!_4 l 3"‘i Y IS IA/1 g)
C, ')1 .: r IP A* u I / b 044 1, .4-. ' Scale: �, )
Pier(dock)length 4'A f 3t/ �l
Fixed Platform(s) ' !6J X i (dt.�•
a .1
Floating Platform(s) i i i 1I ( �"�
liii
Finger pier(s) Ilir.X i--- '
j -- 1...__ ` �i. ....-..
Groin length r I i� l� . Aho
number
Bulkhead/Riprap length ... .. _._------_�—_---
avg distance offshore —� ��_
i j45 ° I �-- / ;X 13 :
max distance offshore otb" : ' / 1 i
• X LA-4 Basin,channel i . / 1� ' 1�+
w i
cubic yards Pi e ft "'
Boat ramp At —
tt
cam- /;'X i 3 _...... -
Boathouse/R3oatli _. ,_ _. _ � ._ _
Beach Bulldozing — ._ -- —_- a— I__.
Other -1.,-- 3L' All , ''
,..),40- y T i 1 i 1
i
Shoreline Length lc G \ � � 1 4 T "` •
i
•
•
•
.71 i1
SAV: not sure yes no ...» ......._ — ............._._.—�_
r : -III
Moratorium: n/a yes E D� # —' _ f ` �j1
Photos: yes n- _ I t 77
Waiver Attached: yes no i 1 (' —� r i f
A building permit may be required by: F1k ;, { (,wWH I 17 . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions L.c4 I )`"r' _j•-, ✓l)• --L` ,.i 4'
E4111411( V (.."'"/"A"4) /
Agent or Applicant Printed Name Permit Officer's Printed Na
compliance statement on back ofpermit** Signature -'
4
Signature Please read p g
f ► '. 4`G ►.==- 1632- . nC t 702 - - rd, 7o7 i
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
'"far-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(910-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret, Craven,Onslow- (Serves: Beaufort, Bertie, Hertford,Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
40I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

A ROY COOPER
t`t. Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 026.0233 & .0259.The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act(CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party (contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to $25,000 per day per violation.
i. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
• Pre-project site conditions: "Ie 15 beacL, Ir 14' tie
By your signature below you agree to be held responsible for meeting all of the conditions listed ove a d verify
that all information provided is complete and accurate. /']
(AN\(2_10})-w '.ie,(,k) li )
Age t or Applicant P anted Name Permit 0 cer's Signature
te,4; Ativ\,
Agent or Applt Signature Issue Date
CAMA GENERAL PERMIT#: 7-7-HiJ•
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington,NC 27889 1252-946-6481
Wilmington Office 1 127 Cardinal Drive Ext.Wilmington,NC 28405-3845 1910-796-7215
Morehead City Office 1 400 Commerce Avenue Morehead City.NC 28557 1 252-808-2808

99QL e.Q92 0000 °EIT 9T0L
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A. Signature
USPS.comC� - USPS Trackin ❑Agent
■ Print your name and address on the reverse X
4 V CA o Address,
so that we can return the card to you.
• Attach this card to the back of the mailpiece, B. R gRived by(Printed er ) /i E. Date of Relive
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item ? ❑Yes
4�LIn55�i, �"C aL2�`� If YES,enter delivery address below. ❑ No
USPS Trackinc
Mt n, 1L Lp CLL
3. Service Type Li Priority Mall Express©
1
II II1 1111 ll I III' 11 I'I 'I II I 111111111 IDAAdu AduMlt
n Restricted Delivery C Registered
Registered
MailrRestrk
Cer9590 9402 5101 9092 0175 53 ❑Certified Mall Restricted Delivery CI Return Receipt for
t7 Collect on Delivery Merchandise
2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmatior
D Insured Mail ❑Signature Confirmatia
L]Insured Mail Restricted Delivery Restricted Delivery
(over$500)
PS Form 3811,July 2015 PSN,7530-,0 -A00.8Q5t3; • Domestic Return Recei,
Tracking Number: 70181130000018877866 Remove X
Your item was delivered to an individual at the address at 2:10 pm on October 14, 2020 in
DIXON, IL 61021.
G Delivered
a-
v
October 14, 2020 at 2:10 pm
Delivered, Left with Individual
DIXON, IL 61021
Get Updates u
Text & Email Updates u
Tracking History n
October 14, 2020, 2:10 pm
Delivered, Left with Individual
DIXON, IL 61021
Your item was delivered to an individual at the address at 2:10 pm on October 14, 2020 in
DIXON, IL 61021.

October 7, 2020
Greetings, te,(44,t) .i?f c12,
We wrote to you in September to let you know that we plan to have a pier built on the waterfront of
our property at Pamlico Bluffs, Blounts Creek, NC, Lot#6 Friedman Drive.
Enclosed is the CAMA Adjacent Riparian Property Owners Notification/Waiver form for your review,
initial and completion of adjacent property owner information. Also enclosed is a hand drawn
description of the location of the pier and boat lift.
Please review and complete the highlighted section. Initial the development proposal. No Waiver is
requested,as the pier location is more than 15 feet from either adjacent property line.
A self-addressed and stamped envelope is enclosed to return the completed CAMA form to me.
Thank you for your time. We hope that everyone is doing well.
Carolyn Erwi
4175 Dale Drive
Farmville NC 27828
252-714-1516

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: IZaittf ( + Olr rwtei
Address of Property: Lot*() I-Twi!'(=bf) n/6w INAJ Dourcis Oak,a/ et49-
(Lot or Street#, Street or Road, City&Counfy)
Agent's Name#: b Cattlict to Mailing Address: 13 Klairic a
Agent's phone#: 252'5-v61 l -Tor& LICE 1780 LP
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.
I have no objections to this proposal. _ -__I have objections to this proposal.
If 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. Correspondence should be mailed to 943 Washington Square
Mall, Washington, NC, 27889. DCM representatives can also be contacted at(252) 946-6481. 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, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
atifsf(")
°Atialft
Signature Signature
Clt-Rol ,J uN(
Print or Type Name Print or Type Name
4175 .le:rri
Mailing Address Mailing Address
l ikO 2-7729
City/State/Zip
City/State/Zip
2 3-- (,/�'l C.,
Telephone Number Telephone Number
10-7—202-0
Date Date
Revised 6/18/2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
•
I hereby certify that I own property adjacent to- Cz1 QJ( �' l p EYLJ 1 i'I s
oateriti
property 1V fl I�I1')Q�'1 J1 i�J1004. o P arty wner�, t
located at e rty
(Address, Lot, Block, Road, etc.) ��+�
on PQ,Yw I(A 1�1Vet(' , in B touxlt5 CreeK. T Co, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback m n r�.,q uir e e t.
(Property Owner Information) (Adjacent Property Owner Information)
•
.S. Cidivr471,0,4/L J.),"
r SiKnuture � I l
Prin or Type Name . Priri or Type Narhre
/1)75 e riVe r 1 i3 Hono 114. i4
MailingAddress I ( t7 2S Mailing Address
Cif S ate/Zip City/State/Zip
a--TI%LC51r'� A5a, - -WI- 32)5.3
Telephone Number/email address Telephone Number/email address
hate Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature`

October 7, 2020
Greetings, 14k• :
We wrote to you in September to let you know that we plan to have a pier built on the waterfront of
our property at Pamlico Bluffs, Blounts Creek, NC, Lot#6 Friedman Drive.
Enclosed is the CAMA Adjacent Riparian Property Owners Notification/Waiver form for your review,
initial and completion of adjacent property owner information. Also enclosed is a hand drawn
description of the location of the pier and boat lift.
Please review and complete the highlighted section. Initial the development proposal. No Waiver is
requested,as the pier location is more than 15 feet from either adjacent property line_
A self-addressed and stamped envelope is enclosed to return the completed CAMA form to me.
Thank you for your time. We hope that everyone is doing well.
Carolyn E in
4175 Dale Drive
Farmville NC 27828
252-714-1516

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 aLAd Y ,t't)Lir> Er14LA,
Mailing Address: 4/ 175 iv ,
MG, 27g,zi3
Phone Number: 25 3 Ca 7- tv Z Z
Email Address: it :v C.{eA,,v V11.% 110 f4 l'vtu.c.:t s i �`►�'�
I certify that I have authorized c t) ,v,L'L, i e'_; A v1,1(
()Agent I Contractor
to act on my behalf, for the purpose of applying for and obtainingin� all CAMA permits
necessary for the following proposed development: 15/3 4Ceit vv ,i( ) ,()16\7;
at my property located at l 17- 4ried uti l l (,c are , ,
in �e - kf-i" County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
aka
,,J Signature
Print or Type Name
Title
10 l 23 / 202 0
Date
This certification is valid through I I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: gan� + �U�4�l h £rW'IYI
� y
Address of Property: 1..0t-4F(Q Fried tVlarltirj Qt.tyliAw j $hurt-S Q'l A KIDeetr oe Co-
(Lot or Street#, Street or Road, City&County)
Agent's Name#: )40b Caftki W Mailing Address: 18 141o.for
Agent's phone #: Z52-5O-oci5 - akr ra.. LLC.i 2.78oLQ
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management(DCM)in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 943 Washington Square
Mall, Washington, NC, 27889. DCM representatives can also be contacted at(252) 946-6481. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
autcjiA.) i•
/U4'17ri )6-d-del/ 0344LCQ' ;14.41$
Signature Signature
Print or Type Name Print or Type Name
Mailing Address Mailing Address
ICE 2782c >4;14) ti. j,/ 4.!
City/State/Zip City/State/Zip
.2 5 —7/4--151 Lp (s oq) 52S-:7-2-4
Telephone Number ``Telephone Number
►a 7- 2o / '2�
Date Da
Revised 6/18/2012