80286D - Wright

• CAMA
/ J DREDGE & FILL No 80286 A B C
GENERAL PERMIT Previous permit#
> , New E Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -
As authorized by the State of North Carolina,Department of Environmental Quality r ��{ z �X�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (J.
f! ; / / , ❑Rules ttached.
Applicant Name 1k zy `, / Project Location: County 1��
Address /6 c T. (4 r l GtAq ju, ,,,,/,4-
- Street Address/State Road/Lot#(s)
City / ; c 1--eG4 V State kCZ ? 44 Y3 `',)C-t-4 ---
1
Phone#f-'/ ) /Z --7 --C _Mail Subdivision
Authorized Agent ,- ' )Al_h O !N City ZIP _
❑CW ,ifkW ,I ,P1A ❑ES 0 PTS Phone# (-- --) River Basin 14J ' O -
Affected ❑OEA 7 HHF ❑IH ❑UBA ❑N/A " - / iN—'
AEC(s): Adj.Wtr. Body4110:20 an /unkn)
0 PWS:
r—
ORW: yes PNA yes Closest Maj.Wtr. Body l9� S c
Type of Project/Activity r—f. - ,a c ,/G O a. / ( i'
40 /
• • (Scale: )
Pier(dock)length _
l ki Fixe\Platform(s) i ei l` YjFloati Platform(s) 1 ,
Finger�er(s) i �
1--; . rtfojimpuptca2t.---i —
Groin len
i iI Li
Bulkhead/Riprab,length l Ji — '
avg distance offshore i {
max distance offshore I t
Basin,channel I f I 1'1 7--A 16
! (i /4-(�
cubic yards i i
lai7)
Boat ramp i
Boa e/Boat!' 1 13. —— —
Beach Bulldozing
Other I
i
n klNiK6145
Shoreline Length /SAV: not sure yes ON1 �__._ ._ — -
Moratorium: n/a yes o i
Photos: yes o I r i —._.. - . .Ill _._. _.... _._.._ -
Waiver Attached: �y� ! -47iWA building permit may be required by: `t {/' it ❑See nback regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
atA . /46/" .4-0----
plic t Prin�ar 14 a A 1�
Agent App �n Permit ;cer's Printed Name
Signature **Please read compliance statement on back of permit** Sign r
700 L 57L.- - — 7 / - 1 zr.
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/ 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 LI CAMA / - DREDGE & FILL N9 80286 A B C
ENERAL PERMIT Previous permit#
��-% '_7New 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 t. C ' -
y� 7 Rules attached.
Applicant Name /7 ti /' �'y c/i 6 ' 7/ Project Location: County
Address .. - 7 /C/ , //,t•k ! . to Street Address/State Road/Lot#(s)
City •4 14 , ./s .G#' State /X," ZfP ' U`l) t i;',---,'---
Phone # (/!6) !7 - -7` E-Mail _ Subdivision
Authorized Agent e.=6 ` ' , (---+ u 0° W 4..c. City ZIP
Affected ❑CW r 'EW PTA DES ❑PTS( Phone# ( _)-" River Basin _(.I • 4 •
❑OEA HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body i 1,"'W (nat /man/unkn)
❑ Pws: Closest Maj.Wtr. Body 1'r c A --;
ORW: yes / no PNA yes / no)
Type of Project/Activity - T
• • (Scale: 4) --)06, )
Pier(dock)length
J
Fixed Platform(s) 1 i • I ��;�
Floating Platform(s) _
Finger pier(s) -----e--12 � )11011N I4 -
number4._.1
I
Bulkhead/Riprap length -- i I 4'11./6 -1C!
av distance offshore r i i L) ,r
g � � � � i i
max distance offshore 1
1 ]� /:
Basin,channel \ 1 { �..✓"� 1` }
/�
7 ,,..-1V I ) '1
��11lIcubic yards � � 444 1 f1 __ f�
__,.._....,_
Boat ramp 1 i ' i j
I
7,
Boathouse/Boatlift> 1 72 k-/J` -.__. _ __._. _ _
.__.
4
Beach Bulldozing 1 I
Other _
,
`
I
r�
Shoreline Length /� V(� ? ( 6 f j I
v j
SAV: not sure yes o — i
Moratorium: n/a yes
Photos: yes o
..---IX' ��, r I __----
Waiver Attached: yes>' . o I + 1
I }f i I - -
A building permit may be required by: `f,.(/� .-4./ 4 P See note on back regarding River Basin rules.
(Note Local Planning jurisdiction) JJJJJJ
Notes/Special Conditions
tit ' . / , (1Y' fit` t-
Agent or Applicant Printed Name X Permit( icer's Printed Name
.'\- !.// —
Signature **Please read compliance statement on back ermit Sign ,
�5"Z .-/- q — 7 1 - Z/
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(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/ 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

i CAMA / DREDGE & FILL N. 80286 A B C '®
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 O��/ 1 �Z�
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ('� .
/ - _// Rules ttachcd
Applicant Name 44 4. �41/< r Project Location: Ckunty ���ili!
Address __1 c-f ,c,..,((( Street Address!State11Road!Lot #(s)
City r State /( ar_ oe Ste-
Phone#�f ) rix---rtadt.mai, Subdivision
Authorized Agent fL/6l✓rS 60.1444 s4/41,y City _ ZIP__ __ _
- Cw �A DES ❑PTS Phone# (..�+}r` River Basin, 44/ •Q.
Affected oEA n HHF " C tH 'l UBA 71 N/A
AEC(s): Adj.Wtr.Body_ / iWA/ 4C _a;-lunkn)
PWS: t •
ORW: yes /�f PNA yes o Closest Maj.Wtr. Body dy 5 C--
Type of Project/Activity r��~�O 1 k0�/ // - •
• * (Scale: Zit:
)
Pie (dock)length �j �(/
Fix Platform(s) �i• • k
`��L
Fingei Platform(s) e /I J w - `,A vtg______
Finger r(s) - �� ��C��`��Jj\/ t�r",r�f'e�S�/
Groin len ' t�/�.
numbe ,{�/1T—
,,,,,,,,,,
Bulkhead/Ripra length
avg distance o hore `�l k (e—
max distance offs re / �'f�, /�
Basin,channel _ x( s( , N�T'
cubic yards (( r6 46/n A('v
Boat ramp_
Boa4aigg k«�
Beach Bulldozing
Other
RECEIVED
Shoreline Length . _ I t k� .
SAV: not sure yes V \ MAY 0 7 20 2 1
Moratorium: n/a yes o \\
Photos: yes og^ ell, ]]]sll DCM WILMINGTON, NC
Waiver Attached: e ...w� , —F A
A building permit may be required by: ; 't4f!teL!t
_ ------. See no a on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
•
. AlAgent or ALp t P in Perm ,i' /rs Printed Name
l - = 410
Sig cure **P se read compli ce state - ton back of errnit** Sign. .fd.
ApplicationFee(s) Check It Issuing Date Expiration Date

I
tri,A'CAMA/ ❑DREDGE & FILL 1V�T o 80286 A B C
ICED
GENERAL PERMIT Previous permit#
�C% New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality D at 1 /��
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
/ - /�❑Rules ttached.
Applicant Name • i'e01 4* I/l ►� Project Location: C unty I".t 1 _
Address 1 ,f ,,,, /82/ Street Address/State Road/Lot#(s)
City ( '1f f"e�� • State /(e ___G.r .r�� s�
Phone#91 ) r/z-7E'4et_Mail Subdivision
ea,
,, s
Authorized Agent C ✓/s, .4a S4f4y City ZIP
Affected ❑cw eVA ❑ES ❑PTS( Phone# ( River Basin i/ •O.
AEC(s): ❑oEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 141-1 k/"/it/ na an /unkn)
❑PWS: r-
ORW: yes PNA yes o Closest Maj.Wtr. Body S
Type of Project/Activity �ie_—At O /
If (Scale: /)
Pie (dock)length- .
■■■— I11.-7 ; ■■■■■ I I
Fixe Platform(s) ■■■ I la ■■■ I - l
Floati Platform ■s) j 1 ■■ i 1 ' �
Finger r(s) r __WEL
® �0„'�\ �—I— I - - N
®,
Groin len _ I 1 . ElI I 1
1 �µ ■ I ' 1
numbe --- 1
Bulkhead/Ripra length I 1—
■�� —1.___ '. _—�_—L..._.—.—• �.a
r
1 '
avg distance o hore a■—_■ ■ I 1
max distance offs re —■■ i NMIi /'e _ ! �� Q.
1005
Basin,channel I RE 111111110""—■■ MI(/ (I r — i ,
cubic yards ■■� 1 ■■■■■ 1 I I (�_ ��
Boat ramp / 1 1 ■ ■R■■■ I ■N■
Boat.:. -._._..... ! - - ■ ' i --
� L 2 ■ 1
■� 11
Beach Bulldozing — iii
1 1 i
I 1 l i
Other 1 1 I I
I 1 1 , 1
Shoreline Length / rV6 1 1 _ I ' III
t_
, MINN
SAV: not sure yes •
I ' �'
j
IIIIII
Moratorium: n/a yes I I 1 ,
Photos: yes o i _
I `/ 1 1
Waiver Attached: /9 t ) I — ( 4r ' 1 i
•
A building permit may be required by: e ,A . I See no TA.,
on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
Agent or App'c nt Prin m Perm! icer's Printed ame
�ture **Please read compliance statement on back of ermit Sign r
ZIO 0 . Z—P"----- . P.: u".... go- ( #1 P'''.2.1
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'officerwhen 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:_ _ _
n Tar-Pamlico River Basin Buffer Rules n Other:
n 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(910-796-7215)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 252-946-648 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) '
7Elizabeth 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

E:LR SOUTHEASTERN CORNER / N
OF A 0.39 ACRE TRACT OF / '
LAND OWNED BY OWE POINT `'
DEVELOPMENT, Ma P.P.
MAP BOOK 22 PAGE 47 . / t�W E
PAF ER soot 597 f�°o�\ Qa on /UNDER / �' @ 44: V.
OS Q . P.O.& E LR. WESTERN MOST �o
# Sil.? I' ,4,
K EaOSlIAiG MIER OF LOT 29 OF 49 .
ACRES
/ SPIKE \ PP`gg.6 - MAP BOOK 4 PAGE 63 0.
/� (PER BOOK 3597 PAGE 56)
•g �;a '�:-r ��. sT VICINITY MAP NO SCALE
Z ELP. , I
WERE -11‘ 14,,v ..
, 9,, eg.
PORCH
/ e° Q \.,. • ROCK
GEIMA7OR ��� • ,\• BORDER
PAD HVAC `6, \\ `.__STEPS \
PAD I
Q24f ACRE `S.
NORTHEASTERN LIVE I.. 0,680e Sq.FL
HENRY B. BARNH/LL ii--
BOOK 339 PAGE 285 : O`•
PER BAW 3597 11 `, '� '
PAGE 56) \ ,` `'� Si
p�/�
SWAGE •�� la-
MATCH -
LINE BUILDING % NV/4?,
SEE RIGHT Fa -f �%i, EAR
. i,,,., DISTURBED
4/4;,. .
ELR OR/DIN �p 'rr,, APPROX R LE
HIGH WATER LINE
LOCATED 12/1040
/ UNKNOWN TO �' %;
%i' SURVEYOR '• %o
//lei' NH/GFI WATER loam'
6 • ///�..
�'%. E LP
� OF 7DPSA2 SOUND DISTURBED
.o/ (PLR BOOK ��;
�+/,'j/ 3597 PAGE 56) ••%-
/��' %.
NOTES: '�;�
1.) THIS LOT IS LOCATED IN AN \,\�� P/Llvco
AREA OF 100 YEAR FLOOD. \\\�\' P LEFT
E
PIER • ,o;. FLOATING
2) 014NERSHIP OF FENCES ALONG
R IS UNKNOWN TO SURVEYOR. /' '
�T ` , SURVEY REFERENCE
GRAPHIC SCALE: 1= 40' BOOK 3597 PAGE 56
——��—� MAP BOOK 22 PAGE 47
�
40 O 80 MAP BOOK 4 PAGE 63
Plot of Survey For: NORTH CAROLINA
ROBERT BENJAMIN WRIGHT NEW HANOVER COUNTY
and LYDIA NORTH MIGHT
0.24f ACRE/ 14680f Sq.Ff. I, AM' ER UNDER '~•I n�.M AAT THIS N ACTUAL SURVEY
MADE MADE UNDER MY -••' ' u • 4 T--11ON AS SHOWN ON
TOPSAIL TOWNSHIP PENDER COUNTY THE FACE OF 7H1$P��,;j.�' 0 l.'T ON+ AS 7NE
NORTH CAROUNA CALCULATED BY x,.r :,�, •'.-E . ,_-. BY BROKEN LINES
BOUNDARIES NO "
Legend: PLOTTED FROM RIF';MA„._„•-r ,T.4.... -, THAT THIS PLAT
vetsP.O.B. POINT OF BEGINING P.P. POWER POLE s PREPARED .,..�1•+%,•"•ANC r;-L.HE.STANDARDS OF
E.I.P. EX/ST1NG IRON PIPE IL' PROPERTY LINE PRACTICE FOR ,•;,3'`, r ;_.,,_,..,.;,,-Di CAROUNA'
WITNESS MY ORGY .;,(4-,',-i • 1 . ' SE NUMBER AND
E.LR. EXISTING IRON REBAR SEAL THIS. .4.2 DA ' i• !'da l:;:.A.D., Ma
Address: 1659 KINGS LANDING RD.
MICHAEL UNDERWOOD and ASSOCIATES,. PA
�
102 CINEMA DRIVE, SUITE C
28403 MICHAEL N. U DER
WILMINGTON, NCuCEN�NUMBER L. ssz
PHONE: [phone] FIRM LICENSE No.: SFaC STAMP ,, •
FAX: [phone] C-0615 '
E--MAIL: mua'Izec.rr.corn ©2010 MICHAEL'•UNDERWOOD and ASSOCIATES, PA
e\l..wm 1040WIMMIAMEIiftiold mil nrVA.1A A.MMa�TIMPmapmegnal*w WW2=mw,,ain •

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ZL•J 9-,r4 i COI. 4 A
Mailing Address: s9 I7►,�6s !��¢.✓o�r,l G cecP
fi ►�S.s /�C Z- y / J
Phone Number: 9/0- S Z- 7 g o 0
Email Address: II
I certify that I have authorized C-(S Co,VA 4c,JAY
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at /4Jp X.4,5 IC¢.+1/.14
in (1)tridc/ 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:
--Signature
/
Print c - yhe Name
r1',/%( '✓i —
Title
.? I I 2/
Date
This certification is valid through I I

•J / :: q g '' 11 vas ��; p a2 //V 19 4( caatVidvt47 cc1Ncl 6. 1
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I
' oiVISIQt O COASTAL.MANAOI MEN
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER F
Na t of Property wr:es:. :. �: ,., w,� ^, e'.i
Address of Property: 'J fI�..Witt!
. _ot r Sttebt it, E tlrb t'o1 Road;;Ci,W&C unt' r
Age t` Name#f ____L t'IlQ, Atlailir� Adds. ,1"� �, ,
. Agent's Phone#:., WO - 2-O i'^ ' a 7f_ -r6 #/ =. -,l `:. ,,..,` . ..;,.
0
- I hereby certify that I own property adjacent,to the above referenced prOPOrty °i e tnslivltit3#t•
applying for this permit has described to me es shown on the attached raw3ri h tieve opment
they are.proposing,....A de§cription or-ttrawing, withI l 'trim a Wt �4
have no objections to this rp ostal. la • hje tintis to-thisopths t. ..-
lh p _ _ _ ..
a' -` if you have objections to what is being propose 4 you must notify tits Division of Coa tsi M"aba Q $
t • (DCM) In writing wit?i1n 10 days of receipt�of_this notice.' Contact intorfAtion for'PCM o c.s
available atht-tolAvovw.nccoasfr+tmanapemootR,rii�rlav6pAp'lsp��.f' tiog rby Calling FM _AAT,
r= . No response Is considered the same as--no objaction if you harve balm►otified b t;e„,„rd.tlieri. ,,
WAIVER SECTION
I understand that a pier, dock, Mooring pilings, boat ramp, breakwater,,boathoLiso, of lift-mint -
'`' beset back a minimum distance.of"la"front my area of riparian access.uni+ ca waived by me,:Of .
you 3 h to w e the setback you Ili n 'ilia-apprepriato bip k:be our.} .
A .<<elko wish to waive tote 5t setback regtlirarnertt.
I do not wish to waive the 16' setback-roctuirement,' ''
F•
(PropertyOwner Information)` .. (Rlperia_n Proporty Ow ,vt 10t afl)
',
': ' ' /C
/*/‘ ' '' .. ' ,
S dttrre Sigrtdiur ' ,
k1114 ilki4id - , •, ,,,, ..,‘„,.,. , .,,,._,
Pant ar Type Name Print or Type Name
k zseeo
.> . / mailing AddressIf aflingi Adores g
r
J�.j/f
Clty/State1Zip .. . . - t_'i"1'1' fattalo '," 1' - '
_
,y. / . - - --- i'e1 iyon�►NumOar/E _ liis . QI
- Telep 0ne:NumberI email Address
�.iF(J�'��, It 0 . III
j
l,
.hate Date R v44`" �,i6A
i

:d;
c ARTIFIEp MAIL,- RETURN,R4c JJEci
DIVisiQN OF COASTAL MANAGEMENT
r:
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICA ION/WAIVER FORM
Name of Property Owner. s- 1 t'' in/7/s T _ ,,
Address of l rooerty: 165- 0N4 ' �A Ems+
(Lot or Street it,Street,or Road,City Br.County)
cs 6,►,0 Aor)e.: ".
Agent's Name#. t- C t -r Mailing Address: `.
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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 pror,pasing. A description or drawinq,with dimenst ns, must be Provided with this Iettert,
V I have no objections to this proposal. -7iave injections to this proposal,
' if'you have objections to what is being proposed,you must notify the Division of Coastal Management
(0C6f)) in writing within 10 days of receipt of this notice. Contact.information for DCM offices is
available athtta:i1tri�-wnccoastalmanaoement.netlweb/cnilstaff listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection If you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater,boathouse, or lift must
be set back a minimum distance of 15'from my area of riparian access unless waived by me. (if 1
you wish to waive the setback, you must initial the appropriate blank below.)
/1/f` f I do wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (RI a an Pro rty Owner Information)
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Check
Date Received Date Deposited Check From(Name) Name of Permit Holder Vendor Check number amount Permit Number/Comments Receipt or Refund/Reallocated
Columnl Column2 Column Column4 Columns Columns Column7 Columns Columns
5/11/2021 __ _ Mercer Johnson _ same __Corning Federal CU _ 13416 I_ 200.00 GP#79911D _ _ _ _ __ JD rct.13416_____
5/11/2021 _ _ Chris Connaway _ _ _ Ben and Lydia W right First Citizens Bank 2327. $ 200.00 GP#80286D _ ._JD rct.13473
5/11/2021 Chuck Dealer Marion Charles Deafer GMT _2843 $ . 200.00 GP#79927D _ __.PA rct.12771
5/11/2021 Richardson Construction Jeannine Richman BB&T 1005 $ 200.00 GP#80293D _._ PA rct.12767____.
..__ 5/11/2021 Richardson Construction Tom Lancaster BB&T 1004 $ 200.00 GP#79929D • PA rct.12766
5/11/2021 SAJA LLC Same and Jaynee Wood First Citizens Bank 7476 $ 200.00 GP#79933D PA rct.12769