79166_David Woodruff_20210408

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_.LAMA/ :+-'DREDGE & FILL '�� 's '4.- : : , t.:t_i A C D
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GENERAL PERMIT Previous permit# ,t'/�
New 1I Modification Complete Reissue :=-+Partial Reissue Date previous permit issued w/i4
As authorized by the State of North Carolina,Department of Environmental Quality lJ
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC O7//,//-)0, 0711.1 attached.1 Q 0 / -
Applicant Name DC t,:c att.,_.,'/`4/TZ. Project Location: County_d `~ •~ 1 /de.....—___
``// � Street Address/State Road/Lot#(s) ,•j cPQ ct.v�( /-c.ac
Address �t�l I`fra/��5,..__-St'�._. ___—_.- // /
City e,: —_. State,/�C ZIP.2 7:.5-_4•2 0-t c- � �% Li
Phone#p 9)..?.27 4$SJ E-Mail �,v. e�r Subdivision y�4 -
Authorized Agent 4z: fl _ _..- City -SC-' ,.-loot .-_-...._ —_ ZIP _-
^Cw aEW c..tt6ii aifS` giefS Phone# (5a-- 4 ---_-. — River Basin -"r//��o".. -
Affected ❑OEA O HHF D IN D USA l7 N/A �'✓tr
AEC(s): Adj.Wtr.Body /"k N)4..) �man /unkn)
D PWS:
Closest Maj.Wtr.Body_—ems° '#c---
ORW yes / PNA ��ppyes/// no l��j/' C `
Type of Project/Activity ita/[,4Yt rc 7%oi/or re-5 & //t) ''� -2,S( / �`r°,^f Cr4/e fL i
4y 501fr cacti ' be.r J- f.
et n.c (Scale:A/715
Pier(dock)length--- —. l
� 1v
Fixed Platform(s) — f / "N c P [✓tr-- i
Floating Platform(s) __ _--; I '.. J .....�^
Finger —
piers)----- ., — I I
Groin length 5 �. f
number ____ I . I !
i ' i
Bulkhea Ri p.ldngth y w ' . ! i S •
avg distance offshore__JO _• I ftc0 tiir r5/ ;o r
max distance offshore__/G_ 6*1- ,,f Q _ - . .,�i•Ar�t.-:r, .
Basin,channel — i � f'3uu
cubic yards _.. —... ! ;(`/ li t
•
Boat ramp .l ••\.. I..: _.. f i __Ap. p/L
t
•
Boathouse/Boadift _ _ NottX r !
y I ! I I
•
Beach B `` rY,• I ,50'°el.' •fA1ei e li erc. C
ufidonttg- L... ,.�_ i
,I I
l �
Other.—.....--- -. .... -� y .- -
i OP
J _
•
Shoreline Length-- /,°1 S 0, •
— . _
SAV: not su�' yes no I :1 t _ �
Moratorium: n/a yes I I.. .3 N. , I4i t- . . I .
I l
Photos: yes no _ I �r�. ' . :.�. i ! ,
Waiver Attached: es�. no A building permit may be required by: /17-rl t C/_., . [gee-note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) /
Notes/Special Conditions Xe's U>/�.//0. Q 7//./VZIO. i''4,... J -re L.`�,t ,41/
•
. ct. - _Ltarl..tC,145.-r- 1-1-- %.--C1%-4.,e .1.-- _64,4_, _
or Applicant Printed Name Permi ff cer s Printed Name
. ....._ -_...._ .. . —
Signature **Please read compliance state n on back of permit** Signature
,,CC>_(_�_—_-_ _ __ 1 9.2- _ 4:).-, / f , 2O2/ `.��.�
Application Fee(s) Check# Isstoi ng Date Expiration Date
. I

ROY COOPER
Governor
MICHAEL S, REGAN
Secretary
Coastal Management BRAXTON DAVIS
eNviRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE FOR SHORELINE STABILIZATION
A riparian buffer authorization is required for shoreline stabilization activities within the Neuse and Tar-Pamlico River
basins per Division of Water Resources(DWR)regulations 15A NCAC 02B.0233 and 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. Impacts: Impacts to woody vegetation from clearing and filling in Zone 1(begins at the most landward of either
normal water line(NWL)or normal high water line(NHWL)and extends 30 feet landward)shall be minimized to
what must be impacted for the sound installation of the shoreline stabilization project. Unnecessary clearing and
filling in the buffer is a violation of the riparian buffer rules.
2. Clearing&Grading:Clearing and grading of Zone 2(begins at the landward edge of Zone land extends 20 feet
landward)is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes
maintaining diffused(non-channel ized)flow of storm water runoff through the buffer.
3. Construction Corridors:Construction corridors are allowed for shoreline stabilization projects,but they must be
satisfactorily restored as described in condition 5 below.
4. Potential Overwash:For vertical shoreline stabilization projects(bulkheads)only;sites where wave overwash is
Y. .
expected to be severe,the first ten(10)feet landward(unless specifically authorized otherwise by DCM)from the
structure may be maintained as a stable lawn in order to provide for structural stability.
s. Temporary Stabilization:Immediately post-construction,bare soils must be stabilized as quickly as possible by
providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting.
This ground cover is a temporary measure used to address erosion until site restoration can be accomplished.
6. Site Restorations At minimum,pre-project site conditions must be re-established_A site that was wooded prior to
this shoreline stabilization project must be restored with woody vegetation ata stem density of 260 stems per acre.
Non wooded sites may be re-vegetated with woody vegetation.Restoration must be completed by the first
subsequent planting season(November 1 through March 30)after completion of)the bulkhead.
0 Pre-project site conditions: h/of o,,.:3. �T I,. I 'Af//r,e4i..1. t, ,p /'j CeA,/i.- el 471
_c1 - e 4
1. Project Drawing:The drawingon the CAMA General Permit is considered the project drawin ofyourpropertyLt�s.���ft
j 1 g
indicating the location of the shoreline stabilization structure and any associated clearing,grading,and construction
corridors.This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the above list d nditions and verify that all
nformation is complete and accurate._ %' !;
Agent or Applicant Printed Name Permit cer' gnatur------.....-c2-'t C.-Xst-r- L.‘,,t./,'"( 1( f '2./
Agent or Applicant Signature ' 2ssue Date
/
CAMA GENERAL PERMIT#: 7 Q/‘E�' .
State of North Carolina I Environmental Quality!CoastarManagement .
Washington Office i 943 Washington Square Mall Washington.NC 27889 i 252.946-6481
VYdminoton Office I 177 Carrlf,aI pv,ve E.tt Wilmington.NC 2540.5-3E4S I?le_796-72Z
Morehead ay Office 1400 Commerce Avenue Morehead City.NC 28557 1252-308-2808

NC Division of Coastal Management
Cashier's Official Receipt _ 4 ( B C D
Date: 41a / ' 20-=-'- f
Received From: ��' 6�"��/u $ t 0
U czv
Permit No.: 9/6 /1 Check No.: L[ r '"Z
Applicant's Name: t I l/ Jr. �'47: County: "�^L
P
Project Address:
SKO '!e/�` 1 ZSe;`"._ :," �, /c3 7J
Please retain receipt for your records as proof of payment for permit issued.
�Signature of Agent or Applicant: .i�G� '� Date:
e /
Signature of Field Representative: � ��- • O�'�' Date: �/Zi
A

er : A ✓MA / DREDGE & FILL N . 79166 A C D
G NERAL PERMIT Previous permit# .AVA-
>< I!New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued .4✓/,4
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 07,I/O 0 • 0 7/1 Pi 0 0 •
/ / / / [�'FCules attach�ed./
Applicant Name a'v./c/ L✓is�d///`4(7 Project Location: County ,/y�r/,•_
Address y(2( �r�/e rn<-, -Sty ,,/ Street Address/State Road/Lot#(s) 370 /cc/.vr( 4cnc
City 40e,- State/I/C ZIPa2 7$a2 1 A, 4 /( ,./Phone#(9/9)-2a7 ro 4/S7 E-Mail _elev,.,"6)/0 S/ce(.can Subdivision /1
///4
Authorized Agent Ar/A� City Sc r-cs.ta,4 ZIP �-
Affected ❑CW Li'EW II I4 [LES- i fS Phone# ( f e /c River Basin am//r"'
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body c�h c� "--`"- tells/man /unkn)
❑ PWS:
ORW: yes /� PNA yes / no Closest Maj.Wtr. Body �A^•f 6 #' -'
Type of Project/Activity A.W cv-let y 9 t2// `,I re-r °A/4/L� 2 `-Z�`'� �ra i..r Sfp�.�
y SO,— Ve>, 6u l ti n< (Scale: /J/js )
Pier(dock)length
i , i I
Fixed Platform(s) i � /� IeYL'r" f I_ 1 T
t / ! "4"t5o� i , /V
Floating Platform(s) f
Finger pier(s) _.__,
_ IL-
_
Groin length o2.5‘
number ......----..._.....— —.--.__.._—.._.�_—.i--...._._..._i.._._.__ -----_---_.._._.._ _.._..._._..._._.__I
i
�y , i �._—_._._ ..
BulkheadRi n h 7 0 —
avg distance offshore //j i {Ae.
max distance offshore /(>� i i �' r i ! ,t :P i
�` i
Basin,channel I I I 1"4? : t i
f I /) I ' jr 1 I I I
cubic yards j (4 d ='r` "'+
Boat ramp I i ..r< I ;
Lnuua--, i y } •
Boathouse/Boatlift —• -- — +---- — 4— ! k
c r
i - --I ,
VI:I . /
Beach Bulldozing Q A M�� st-art f
Other r
j
1 y 11_
- i :
/ .250� r;•r ; i
Shoreline Length _ f .a
SAV: not su yes no ._..+ i. u _ ____.._ _ .___--— .--
�Jr
Moratorium: n/a yes 1ppi f ; 111� } I
Photos: yes no ___ — --, I
Waiver Attached: o ) I -----“- ---
A building permit may be required by: �7 4_ . ee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) //
Notes/Special Conditions fed- , 77 /700, 0 7/4 l VUO , 1,—,�,.• AXre 4,,4-I/( /O��
SLe- / j' / ,
Agent or Applicant Printed Name Permi er's Printed Name
Signature **Please read compliance statement on back of permit** Signature
/6OO! 6/.29.2- ,/,,,,, / p / ,Q.,,,,t 4 .2,02 r
Application Fee(s) Check# IssLing 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

erL'CAMA / '❑DREDGE & FILL N° 79166 A 0 C D
GENERAL PERMIT Previous permit#
)'z EJ'New El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued w/
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 'I. I t/0 0
) / [2Rules attached.
Applicant Name //!'fr,e / /lei,_ Jr. // Project Location: County / //,,,r/,.
Address ,'>6 /,// , -;-/ Street Address/State Road/Lot#(s) `G' /—,-, (.,.- ( isnr
City /JPr State i,/(- ZIP 2 7.5 W-2 c, / / ,V/ , i //, /'I
Phone# ( ',' ') '-2 - G /5- E-Mail (41-..,i elk/-e ( ,i., Subdivision
Authorized Agent ,iz/4 City_ 4,r ZIP
❑CW C4•EW L TA IDES I P'tS Phone# ( --(4�, River Basin ; // '•-
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A J/ �
AEC(s): Adj.Wtr. Body �`" T/man /unkn)
❑ PWS: //
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity r // / ; , 4 I
i i" c. (Scale: /yr )
Pier(dock)length /
I
Fixed Platforms) `,
Floating Platform(s) / J�
Finger pier(s) 1
_ _ C }
✓ }
Groin length ;' I I
number f '
Bulkhead(Riprap ngth 'j 90 _._
avg distance offshore /., r sr I —
max distance offshore / ' 1 j� 1 r 1 j_is` 1
Y ,i� r + C
Basin,channel ♦ !�V i A(i.{
i l'i.\\II ! -
cubic yards I'r
Boat ramp j 1 . 1 - - 1 I 1 12
Boathouse/Boatlift �� ! T_.._ �
Beach Bulldozing jjO J��.,. J7, <„L •!•. i I \
Other 1 .' i
1
Shoreline Length /.2 i" 0 . 1
f i •
SAV: not sure yes no . - r ;r�. I '
i' I
Moratorium: n/a yes no—, 1 I c
Photos: yes po/ r 1' i- 1 ......._.._.4
Waiver Attached: yes no I / 9�+
A building permit may be required by: ///ei L �c, . [glee—note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions : 6. "// //67U 0 7/7, /(7 0 , i--,,,., lA,, i, •'Ai( %lJ7!
Agent or Applicant Printed Name Perm' Off' er's Printed Name
Signature **Please read compliance statement on back of permit** Signature
16 U0 /2 2 ff ,-: / cf 0-2/ / ', ,202 j
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 I 5)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
401 S. Griffin St. I 27 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

_ _ �T
,[IICAMA/
❑DREDGE & FILL No 79166 AC.) C D
GENERAL PERMIT Previous permit#
>� ONew ill 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 5A NCAC
❑Rules attached.
Applicant Name Project Location: County _ . _ : . ---- f/� ;to
Address Street Address/State Road/Lot#(s)
City State ZIP % <..
Phone# (___) E-Mail r / Subdivision
Authorized Agent City ZIP
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Phone# ( ) River Basin
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity
(Scale://7_, ) ,
Pier(dock)length
Fixed Platform(s) i I ' /- r ,' { f
Floating Platform(s) I . ----1.--.,_;
Finger pier(s) j _ f { — — — ,, I t
f
Groin length i
l
I
number4-_�__._..............._._..._---.___._...-- -.......... ----........_.......--- --
Bulkhead/Riprap length I' 'i L' _ —•---
iI I i -1 I
avg distance offshore ,_ r
i
max distance offshore /t. , 1 [! i` ? ;, ,
, i
Basin,channel r Iii
�
i
cubic yards /� V
Boat ramp l {
Boathouse/Boatlift =..._._._.._...__ --.�- L_._-.1 �.-- I --.__..-.- ,_
i
Beach Bulldozing — ' -' t) ■ '
Other I ` II ,.
.. v} . 1
I
Shoreline Length /, 'I-' I I
I
C.,--
SAV: not sure yes no __ 4 l--- i 1
Moratorium: n/a yes no.
Photos: yes no f I
a-._._.. t._ i.. (_
Waiver Attached: yes no � I '� . ' I
A building permit may be required by: / ' (. I t See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
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

David Woodruff
From: Staples, Shane <[e-mail]>
Sent: Monday, March 29, 2021 4:49 PM
To: David Woodruff
Subject: RE: [External] 580 Federal lane general permit for rip rap
Mr Woodruff,
I have the adjacent landowner signoffs and the proposed work drawing so all I will need from you is a check or money
order made payable to NCDEQ sent to the mailing address in my signature line below.
Thanks
Shane
Shane F. Staples
DCM Field Representative
Washington Regional Office
[e-mail]
office: 252-948-3950
cell: 252-204-4081
943 Washington Square Mall
Washington, NC 27889
From: David Woodruff[mailto:[e-mail]]
Sent:Wednesday, August 5, 2020 11:11 AM
To:Staples, Shane<[e-mail]>
Subject: [External] 580 Federal lane general permit for rip rap
External email.Do not click links or open attachments unless you verify.Send all suspicious emain attadnt to
Mr Staples
Thank you for explaining the permit process to me this morning. Attached is the form and map we discussed. The
property is open for you to inspect at your convenience.
I will call you back when I have a better idea of the projected schedule.
Thanks david woodruff
(M)919-227-6453
1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
3d:K1 Wood,.fl
I hereby certify that I own property adjacent to 's
r4,4,r L(Name of Property Owner)
property located at _ �` `'
(Address, Lot,Block,Road,etc.)
Pungo Relic on , in , 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 requirement.
` e t car (P.reperEy Owner Information) (Aedjaceft•Property Owner Information)
Z. , �'' � c (,,�(
Signature Signature*
Douglas P Carey ,\ I ! ('
Print or Type Name Print�or//Type /Name
2857 Horsemens RKig Ali l( ✓ !✓ G I IC/-r"
Mailing Address Maili Address7 _
CIaY ' `(
o^NC 27520 7 /� C 2•` �
City/State/Zip City/Sta e/Zip—7
919-342 5202 ill- 2•f � .�
Telephone Number/email address Telephone Number/email address
Aug 418.2020
Date __- — Date`
(Revised Aug. 2014)
*Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to .N O .) `G G Q CI J' 3'4- 's
(Name olPr perty.Owner
property located at D '6 c e ti 1 Ck L G t ( ` 0+ 3 r
(Address, Lot Block, Road,etc.)
on Y :.r Ng s tk_k-v , in ( ('_;cz.ti 'j-s�.4 , N.C.
fWaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. f
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. (i_ vi'sh to waive the setback,you must initial the appropriate blank below.)
l do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent Pro rty O e Information)
l`t -,--C (-6C:" ,)o7W -
ignature r Si �(e
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Print or Type Name Print or Type Name
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Mailing Address M 7ing Address
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City/ to l S%t'c' City/StaterZip .N,,:,+.i t�i-o:.r 4.t t . A,Av C.
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Telephone Number/email address Telephone Number/email address
'7_ 1-1 - Zs-) "1- zit-
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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