78037A_Thomas, Terry & Clara_20210224

':-.1 :_ ���t���=:�1 •..,._=1 :x t= =mot
property boated aE r ;t- "N o Pm
y Oe
1 I=in
L•Block, AL
on-{ t k Q l N.C.
(Walerbody) (CN&YTown andtor
The apple= t has described to me, as shown below, the development proposed at the above
location.
A-4, t-I.,. i have no objection to this proposal.
DERCRIP I ANDfOR DRAW NG OF PROPOSED DEVELOPMENT
(A difalkmetp-opushi rills-m—p wetrtoustREy,da�.uipewrhobo ore 1 1, asAledtmadoW
WAVER SECTION
I mlerstand that a pier, dock. mooing pings, boat r rtnp, breakwater. r. boathouse, lift, or groin
must be set beck a mirrin mn distance of 1S from my area of riparian access unless valved by
me. (it you wish to waive the selbadk, you must iniliial the appropriate blank below.)
I do wish to waive the IS selba& rye *ement.
I do not wish to waive the IS se>back mWirernent
(Properw Inrormart�i n) i ProPwy Omm lydwmalion)
Signabae Signatune* /rt
Pt" p' Nears �� __ FhW or T-�
i7 t I- i � F-to � _l, r" ��� % I fir c yr,..f bir
AfqftAddrewp j ( Addrew
sl y 7 r/ 5 3S"�
Tekphom Numberler AN ado *= Tale AGW l67W addmss
') . ")LO y
(Rsvimd Ato 2014)
Valid for one calandw year after aigrmrse

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
�y certify that I own property adjacent to�€..i' `� -+ CA t Q r D , 1 h o nn g.1 's
of Property Owner)
property located at 0 cr I t I i. J
(Address, Lot, Block,Road, etc.
on �C ;,rx.4't (} �J.yy'v- , in E t � 4. N.C.
U� J rbody) (Citytfown s"or )
The appNcant has described to me, as shown below, the development proposed at the above
locat -
,�/ I have no objection to this proposal,
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(l xNvxkW proposing development must fig in dawjWUon below or attach a sine drawhW
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grin
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 16 setback requirement
I do not wish to waive the 15' setback requirement
(Property Information) (Adjacent Property Owner Information)
rk
Signature + St ture7
I �rL3�N,�s*Y.sxS CAa-►� I komctj ,✓. ter'
Print or type Name Prbtt�pe Name
MWft Address , M-A& g Address11
r
�:��yw�LtA2,7-f7h�11.(.��,�
. D' i` .!. l `� t� I ryt tY+riSt�s� t er` ` ;Z9 r7 Ff i
Telephone Number/email address Telephone Number /arm# address
l jam; -!;- /t) *,;to • a
Date Date*
(Revised Aug- 2014)
*Valid for one calendar year after signet W

h

Pasquotank County NC
February 22, 2021 1:584
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NC CGIA, GeoEys, Mom, Mlcroson
0.03 km

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