76896A_Respass, David & Phillipe_20201005

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DIVISION OF COASTAL MANAGEMENT
Received ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
DCM-Eq hereby certify that I own property adjacent to 'f ule'IeyeiaT 's
(Name of Property Owner)
property located at /-�7Y ���� i �� �4Xv" 70( �.t�4 G-'J14a leS ,
(Project Site: Address, Lot, Block,, Road, etc.)
onL4na/ /ea&l,"gI. /; /%�% �T, in 2701-r� , N.C.
(Waterbody) l (City/Town and/or County)
Agent's Name #: & fJ41t Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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If you have objections to what is being proposed, you must notify the Division of C astal Mana a ent
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property caner In ion)
Sigm ytture
411
Print or TyfdName
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Mailing Address
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City/Slate/Zip
Telephone Numb/er / Email Address
(Adjacent Property Owner Information)
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Mailing Address
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City/State/Zip p
Tel hone umber/ Email Address
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Date IDate*
*Valid for one calendar year after signature*
Revised Jan. 2017

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Currituck County GIS Online Mapping
Addresses
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Communities
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Currituck County GIS
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www.co.currituck.nc.us/Geographic-Information-Services.cfm
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This map should be used for general reference purposes only.
Currituck County assumes no legal liability for the information
shown on this map.

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