77444_John Wilder_20201027

--F.13
4AMA/ O DREDGE & FILL -ED 1Dri
FPrev�' 7744
EIVERAL PERMIT D D
New OModification OComplete Reissue ❑Partial Reissue
ious permit# ss
As authorized by the State of North Carolina,Department of Environmental Date previous permit issued
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC
Applicant Name ;2L�0
PpytV1 1 rt.•ules attached. •
Address —�----— Project Location: County µ:Pcb.w,k
__� . 1AltitA Street Address/State Road/Lot#(s)
City State N e. ZIP��'Q 39
Phone#( `� 2__Z sit Yl'1The___ Lev a
�'`I3 E Mai--- — Subdivision
Authorized Agent 5 rt>n� on
,�` City ASLt ZIP_ _
Affected ❑CV1r [?w !? TA DES OPTS Phone# ( )
AEC(s): ' v i
O OEA O HHF O tH ❑UBA ❑N/A River Basin
❑Pws: Adj.Wtr.Body 'e P I v
ORW: yes /6° NP AV. ma unkn
YeS no Closest Maj.Wtr.Body�Q.MhCD
Type of Project/Activity 1, Z -n i I S' ,
�n' as re ,'?v• 4- 2-2 Alt Z c ' / A YM
e z a. Nr)t) r oa o,c- -�w.tf
Pier(dock)length_(1�' X _ e S /
Fixed Piatform(s)_(2,�X Zoe -1 ,. tale. _
r { �T,' 7 '
Floating Platform(s)
,—
Finger pier(s)_ !�. _) �—t �.. _ { I 1 -�
Groin length �� _ i — I r j — '
i
number ;I._f_ -
Bulkhead/Rlprap length f
avg distance offshore 1 1-- -1---
1_.
I
max distance offshore i
,t)
Basin,channel
cubic yards_ i - -
�t
Boat ramp —_ . , _ ! + i I 1 '.,
fTSKI�
Boathouse/Boatlift ! ;
T'
_, 1 1 ....-- i
I
Beach Bulldozing I i 1 j
I i { } t ( L! , k —1—`
.._I—I-_j _ l-._1 I
Other -.
1 '
Shoreline Length 50 { I.
'-j t, 1 ' - . -+- t-
SAV: not sure �_ QQ''''1.Kt}Eoa � �_ i_J_ ..
yes o
Moratorium: r;/a � � ,
Y t,o Nk, ,n, if I
Photos: Yes
Y' -1 yJCoB
Waiver Attached: ' ' I • I 1 11°Y } +'
no 1
A g permit ma •Veiiii, 0Y� l,I}�n�u I i
be required by:
(Note Local Planning Jurisdiction) /See note on back regarding River Basin rules.
Notes/Special Conditions
1 \ 01f .Is WA- ; < ALuyt n , y, '
45 U /I f_ U a f~ I Ok1a�lt�i s ,L y W 1 A -{-�w e'CS. 1T
0 .a 'J, GEC !� a �YI1llnl /Y! c
II i
Ili. •Jlc. t Printed ----_ _ J� � _ »Uy
' Permit Officer's Printed me '
.i
ignatur_ "Please read compliance statement onbackof permit ss ~"'""—1,(
��� COY ovIgo,/ Signature —LL �j
Application Fee(s) t QLT Zo _ '7 "f
Check# Issuing Date /C T In
Expiration Date

41 \ CAMA / DREDGE & FILL N° 77444 A © C D
N E RAL PERMIT Previous permit# 131
) � V New Modification ❑Complete Reissue Partial Reissue Date previous permit issued V I A
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 15A NCAC 71 A • 0Z�������CD .
L,✓Kules attached.
Applicant Name 5 r v kk)I le.-(-- - Project Location: County Bectu-c-b.a' A-
Address, a5,2 s tyy,,,[,' QULV L1sr� Street Address/State Road/Lot#(s)
City Wa6111 State l\i ZIP 0� 262 sl lvY1`(`At_V" ActOeN^ LN
Phone # ( Z) -1-4-- Vt93 E-Mail Subdivision 0Itt
�-
Authorized Agent 1,t S VActrar1L Con , City I4JA51ni ;bY\ - ZIP a*SS Cr
Affected ❑Cw Nri-w RI TA ❑ES ❑PTS Phone # ( ) River Basin-rile Pil �f
AEC(s): ID ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 'Pa Ty)l\LD I` iVe`r AV/man /unkn)
❑ PWS: �7
ORW: yes / PNA yes / no Closest Maj. Wtr. Body ?QYY))iCD iIR[eY
Type of Project/Activity PI Ilac- f l 5 hr1G1 ) Is'
< cc ' p iev• a- 12'� ZO ;741 �✓ )
I r''F051f 7' r•c 4(t (,a7 v"a(k tY?be r coo o-F aL11 vusL . (Scale: I n _ � )
Pier(dock)length I ISM A. b
1j 1I _ ii
Fixed Platform(s) 12 X2o j { or
Floating Platform(s) \ e-id IZ �Ca+M j 1 {
Finger pier(s) — _ -...__ �_
Groin length j ( i j
number j i i St l
Bulkhead/Riprap length } "' • iJ L((�',0G'�1 t.A
l i _ SCS
avg distance offshore p , ` /.--'- - � , 1/ U\k
max distance offshore 9QM`• . 1 'tte rt- 1 Y It; - k
f
Basin,channel ---�--� I �
.
,~ i I
cubic yarr ds (���X w ry�' /'\ I
Boat ram 1 1 .`G / \ LS(,ra� l I
•
. IIII 6�
Boathouse/Boatlift i i- 'I•)6' e —IP + \� �k-._,..._. ( j
I
Beach Bulldozing i
Other - 1 I t
3 c '-.> I l .I I I 1 ' f 1
I NAM- 4 ►�W(-
E I
Shoreline Length { 501 l I i>x SST 2rsL &.<<-K4-i4lo r A
SAV: not sure yes o 4/
p
Moratorium: n/a yes no bL `
Photos: yes n
A building permit may beby: �eo�U.�or)- CDUYIT See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) \\ l
Notes/Special Conditions La is Y`r�..v-,-itt'ilcU laws Wv I -L a 1^w 'l"e'C-S• . 'Djp)1Cah
*
65 647h i1 ZLU al I all owa4 Sg /4✓G 4,),C Q.s P.,e( of ,4)1rY.N' 4601 0-
oa S I i-
14ohley (money
Agent or Applicant Printed Name Permit Officer's Printed e
044filja
Signature Please read compliance statement on back of permit" Signature
Pc CtiY -fix, 1g04/ a - oe-i- - Za 2v - 24 - ), - Zozo
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 (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-7215)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

•
41❑CAMA/ ❑DREDGE & FILL N9 77444 A Q C D
GENERAL PERMIT Previous permit# NI A
�� New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued 1.1 I A
As authorized by the State of North Carolina,Department of Environmental Quality 1'
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC R . '02L��0 •
\\ R'Rules attached.
Applicant Name �D�r w 1 'U e'' Project Location: County i t-c1 'CT-ar A.-
Address a 'Mw
5a Su i)i:1\`Jel IA Street Address/State Road/Lot#(s)
City Wash) o State'J C ZIP 3-(N-1 =5 L 5 mere( Nu..)cr, LtI
Phone#(25Z ►-4 • 11`I 3 E-Mail Subdivision N I vy
Authorized Agent j)S A kk v V,1 e Conn • City .. S\(1.,r5*r-n ZIP ).4C5SC(
Affected ❑CW IYIW C TA ❑ES ❑PTS Phone# ( ) River Basin 1 )PYI I//
AEC(s): ❑oEA ❑HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body P/.1 YZ'111'LD R It r nat /man /unkn)
❑ PWS:
"� Closest Maj.Wtr. Body /11'11)1(D )`r�r
ORW: yes /6 PNA yes /6 �
Type of Project/Activity t -?O 5�")).41 1 1'/,dip I p,e ' • /2 • ?C' 7/.r"746 cry-)
_ - ( R.) r V iae t ' ��I i t4Y)(`4 - c(..)t,F a'- r `Sc le: _ •
Pier(dock)length I IS' A 6 ' SC )Fixed Platform(s) j a'X 2C I Z
ilii / e I
Floating Platform(s) . 1 \ �l d,- C*'tM —_.. _ --
Finger pier(s) 1 1 1 —_...._-- ....._.._......__. __._..
Groin length
number l --^.__._._T -- .........._— ,_.. ` pp
I __ j k t)1 , 11 e 1 !t
Bulkhead/Riprap length I r �� '! L t' IA
{
avg distance offshore ^�i C t ..,1 V�
max distance offshore ? Zit/if/hi' ' e, ` r
>�Qtr11�D ' �J i
Basin,channel �"� 1 I
cubic yards I y �n L + i
i
Boat ramp I -(-''` -yea 1 1 C.,46
Boathouse/Boatlift --- i _ � 1 ' • j t%X __ ,
Al
Beach Bulldozing i -i---t-- ii,
Other \ .
E . i f
l
Shoreline Length , rJ Cl i i
).151� �laL Q,u ri tab,. ! I
4
1 s
SAV: not sure yes Qo ,F /7 --1 I P 1�w�a i
Moratorium: n/a yes o ` �r _ 7.. i
Photos: es 4-'\ +
Waiver Attached: O" no ' l ,
t_AV- (j, 1
A building permit may be required by: [Je(MN'fc[i(' L.DIAS\ y . L`J See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions - trU,r\a 1(v I:_I w✓i W i-1-� U -c-r 1,/, ',, t�t' . , . /
w,..U, S�,/,, -Ie.,-fir 615 I"(/1 .... f /lN ',Ig ',Pei i► 40/711",'. .
4hl'ey (rar y
Agent or Applicant Printed Name Permit Officer's Printed �*e�
** onback of permit** Signature
(/
Signature Please read compliance statement p g
j)J C h k 4Zo6. l410gl a� - oL} - zo?.c> — 24 - Fcl, - ZoZo
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 (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-7215)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

0 uCAMA/ ❑DREDGE & FILL N9 77444 A BCD
GENERAL PERMIT Previous permit# '_ ,
>'( ❑New ❑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 15A NCAC
DRules attached.
Applicant Name i +\ Project Location: County - . t- t
Address 2, 2 :`.,i,� n--- ,AJ Street Address/State Road/Lot#(s)
City 411 0 ! 1 State ZIP 1 '
Phone#( ) ! 11'' E-Mail Subdivision
Authorized Agent 1 5 City . ZIP A 4`S`c---t
Affected ❑CW Ertw E PTA ❑ES ❑PTS Phone# ( ) River Basin 11I i 041 l4
AEC(s): ❑O� ❑HHF ❑IH ❑UBA El N/A Adj.Wtr. Body ' (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity
(- . e: j )
Pier(dock)length 1.
Fixed Platform(s) , - - I x `
'
Floating Platform(s) !..■.■111■■. ■■■® ■11 (�t _ �����
Finger pier(s) 1 1 ......
Groin length Ett
11
number I. i ,, , ,
= = , -t... ''.........._ _,: ,
Bulkhead/Riprap length ®im ■`■im ■. ! ! -+ t S • _i_ j
avg distance offshore ■■•■•••• I 1 - • 1 �1_._....
max distance offshore , , ' hill' �g1if1i. MIM ���I �R��
Basin,channel IIiiiiiiIlIIIIOhIHH
IIIiIIHIIIIIII
cubic yards 1 _ ■■■ ■ ; 1111111111 7.0. ,11 1 I
.
Boat ramp I
U
1111m1 , 1 ,111
i
Boathouse/Boatlift ■ - L._...... :.. ..__. II III
f -
i
Beach Bulldozing • • 1 1 ••• • ■�I 1111 1 ion ! , • Mil MI
Other \
Milli
111111 -
uuuu•sa• uuuruuaa 1
■■••11 uaa•
l ; 4
Shoreline Length # i f '� ( -•' ` ,
SAV: not sure yes no '—_...--- IA_._._
Ill
Moratorium: n/a yes no! , t_ �
Photos: yes no i r_rt !..—_ j.
Waiver Attached: yes no ' i
A building permit may be required by: ' ` �! PI See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
f1'S1�/e y 6%co)' ,Y
Agent or Applicant Printed Name Permit Officers Printed e
4,
Signature **Please read compliance statement on back of permit** Signature ,
I'(` !I4Zf>(1, F—. /zi cii/ {,e,-4 .. ; . Za., 21 F-6 - Zeno
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(910-796-7215)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/ 1-888-4RCOAST 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

ROY COOPER
Governor
MICHAEL S. REGAN
Sea-etary
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.
z. 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: Lo+ IS 47A, T�1 1 eb Sawa w r
By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify
that all information provided is complete and accurate.
Agent or Applicant Printed Name Permit O icer' ignatur
ZnLG
Agent or Applicant Signature Issue Date
CAMA GENERAL PERMIT#: 4 d'IV 3
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington,NC 27889 1252-946-6481
Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-3845 1910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City,NC 28557 1252-808-2808

—........... . — • LPr,.e. .' rro�
Authorized Agent Consent Agreement
Vsi I LpEt.
(Property Qwner(s)) , herby authorize Tobin Jay Tetterton of
TJ's Marine Construction,LLC to act on my behalf in obtaining LAMA permits for
the location listed below.
PROPERTY ADDRESS:
/62 vMli E R 4 ANiEt1 L�f
PROPERTY OWNER'S MAY.L..LNG ADDRESS:
6 E �s A o !E
Phone No. d•64- in I 1 ti-3
t\AK1D.
PROPERTY OWNER'S SIGNATURE:
AUTHORIZED AGENT SIGNATURE:_ ��i+..-
OBIN TE'I TERTON
DATE: / 2QZ1
1
WIAuthori=ed Agent Consent Agree.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that 1 own property adjacent to \\OiktiV 15)e-(2— 's
propRrty located at_1-C)- MtNEIQi� �i� (Nawf-Stf1N F"�U N ropertv e _/
AI l `f (Address, 1. Bloctk, Road, tc.)
an t t vt Y � , in(Address,
} N .
(Waterbody) (City/Town and/or County)
--, The appl' ant has described to me, as shown below, the development proposed at the abrve
locatio .
Adiacent I have no objection to this proposal.
Property
°i"mef i have objections to this proposal.
Check one
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawl g)
o Aa>, 10 11 — g4160 v F z! A ,/(1
1,ir ,
WAIVER SECTION
Adjacent understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or goin
Property
Owner must be set back a minimum distance of 15' from my area of riparian access unless waives by
must me. (If you wish to waive the setback, you must t Initial the appropriate blank below_)
One
/ I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15'setback requirement.
operty na Information) (Adjacent Pr perty Owner Informatiorj
i'trrt_ •
P or T a Nante Pri'it 9r Type Name
C` fe i City/State/Zip
3
le 41p(� her/emati address-
7� p,
f h° crt� L er�!email a�ddrss tr
o
Dam T__. to*
{f irs d Aug. 314)
*Valid for one calendar year after signature*

1
A v
JA T PROPS ST E
1 hereby certify that I own property adjacent to \\oitl 1(PE .,. :s
Pro ProPmly located at 4.)- PAMEt1114Et i i( yr' ' tt ti pN �C.
on \�i A [ ,•
(' (Address, t Road .)
�� Y�� L in � ys 'C (D; N.
(Vllaterbody) (City/Town and/or County)
- — The applicant has described to me, as shown below, the development proposed at the absve
location. o,�,1
c �'
AdJac - \'` I have no objection to this proposal.
Property
Owner I have objections to this
Check one proposal DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must Mt in descripifan below or attach a site drawl's')
0Y i
t4b O4*Jk za Tilt" P Si(N OF 1t
P«1 qoirl 1JFt"
xdiacenr WAIVER SECTION
Property I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grin
Owne: must be set back a minimum distance of 15'from my area of riparian ara-ps unless waived iy
Must me. (If you 'sh to waive the setback, you must Initial the appropriate R + pP priate blank below.)
i do 'sh to waive the 15'setback requirement.
i do not wish to waive the 15'setback requirement
( rtktfartnatlon) (Adjacent Pro
iparty Owner In n)
P or Name ` f l��k) l 09 �/ ,�( '�j d
P7amM'►E4 NV � oraTS Name
�.t.ft+_,---vim ..01 tT� _1 +--�
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