79725_City of Washington_20210513

l2.)cy
SECAMA/
❑DREDGE & FILL "_P°44�g, 1`T C N9 79725 A ® C D
GENERAL PERMIT Previous permit#
Ii
JNew —Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N' {�
>'
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
ElRules attached.
Applicant Name C1 /1 y e) C 1/0GS1iN941/ Project Location: County .. Ca f --
Address P. Q. Box / `1�'� Street Address/State Road/Lot#(s) Sac L- s r t.; I.:-
City AJA 517l/yin Statea'i C ZIP - q :f LA,_ 51, r: / ,t .7Gf _/r 1 vc
Phone#( )91 ;- 650 E-Mail wJL</4', «u54••,/?1 Subdivision --
Authorized Agent City ; ,,r -� ZIP "45FSq
Affected ❑cW EW $PTA LIES VPTS Phone# ('S 7)9 y3-ss(05C T River Basin fZ / Ill
❑OEA ❑HHF ❑IH ❑UBA ❑WA
AEC(s): Adj.Wtr. Body . ,-,, k S Ccee(= (nit/man /unkn)
❑ PWS:
Closest Maj.Wtr. Body 'FA n7/l<L., P i ,--
ORW: yes / no PNA yes / io
T '- 2/, ��,�.��
Type of Project/Activity '-< ' ) 300 . % P S
4.4/4. 0 N1 W 4.- (Scale: / - 50- )
Pier(dock)length ,
1
Fixed Platform(s) i' I j
i , 1Ci4/�+S ��
Floating Platform(s) !! 1
Finger pier(s) '1+--- _
Groin length -4 ` / — ��
number ....... : . S �Q -...
Bulkhead/Riprap length ' 300 � min ---- -
avg distance offshore / I i I
".
max distance offshore .' ' I jt
Basin,channel j -
cubic yards f ' ! 9 ' "1/
Boat ramp 1
i
Boathouse/Boatlift ii, ; -_.._._._...._..- X VOA .--.
� ._..`�
Beach Bulldozing ^n ,r i ( Q 1 1
Other / ►" ( ^ ry i \ ( —i 1
f ' .i
�� � ;ram �� � RiN �� ' / � �� ° I �,
.:tea p'
\,41 .._ -- .ice sir 4.71: _';
Shoreline Length + S(G(� i ,C.: �� �„�'z, ��rr�rl���i�i�.�ri ri r�irt�.r �.r., a _
SAV: not sure yes 2- i ' ..� -
1 I
Moratorium: n/a yes no i___-I,,.Y_.;_ = _ I eG I j �..............._._.�
Photos: yes no I_ '�'' ' { 'i.._._._ } r._
J
Waiver Attached: yes ® I 1 1 1 I A .G
A building permit may be required by: f3f/0,- T7..rf ( is _ L3 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) F
�Special Conditions
��_�" ..1 ��,d sty,,„,.� ��... .
Notes/ ,(-7, ,
Sr`f)"e W.,,IK si,cclr I f ('iM�.t�ei/.) (rGi v +( o.i a er lCrrl/ •
wC.-‘--Y r _ C .•1/ + Vj ,1r-• 4igy 6r0 L),
Agent or Applicant Printed Name Permit Officer's Printed
/Li-4h--N....... /1.„.- - Z
1,..a3/„.4)."
Si nature **Please read compliance statement on back of permit** Signature
�Y� 5496'. % 3- 4)a • 2O2I - i -z- Si -e07,
Application Fee(s) Check# Issuing Date / Expiration Date

Statement of Compliance and Consistency p e cy
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may thepermittee to a fine or criminal or civil action; and maycause the permit to become
subject
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 252-946-648 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. 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 CAMA / DREDGE & FILL =D#(DR`"T�� N9 79725 A B C D
GENERAL PERMIT v1 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
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC
- Rules attached.
Applicant Name Project Location: County
Address Street Address/State Road/Lot#(s)
City _t )" 'Ef, ?i'-,r State , ' ZIP
Phone# ( ) `!... ""< .,;_- E-Mail _ Subdivision
Authorized Agent City ZIP
Affected IDCW ❑EW P PTA ❑ES LiPTS 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 7 -_r_P
\A ICJ i (Scale: ',G )
Pier(dock)length {
Fixed Platform(s) { 4 ? i
Floating Platform(s) y/ , i I
i 1 1 - -1 -
Finger pier(s) -, L ! �,_� i ,..._.�4,---
Groin length ...;r I �--
number �t• *- „—.:— I,<--..r r
Bulkhead/Riprap length --' _ __ . i .I.-..- ,.�. .--._ i — _....
av distance offshore y t I — ---
g 1
max distance offshore F- . I 1
Basin,channel i j ' f
cubic yards f‘.
11
7> I J
Boat ramp i P
`I �'
Boathouse/Boatlift f }�r --+— ��, __..,
•
1 —__-..H. ' :
4. _..... r�. t - (_.._._� __ _.......
NP
Beach Bulldozing l ---- \� . p
Other ? t iy 1 f1
r 1 �A
U
'I E , a i K
I '
j , 'i v�, I
Shoreline Length / I s _' � , ' �i i - - : ; '.r ?'1.'
' ' - 1 r , _
_„ �
SAV: not sure yes i.no -
{ y 4J
Moratorium: n/a yes (no ' I - £ L r1 i
Photos: yes (no i- I �,
Waiver Attached: yes (no
A building permit may be required by: See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions .r -- '
//4111,p /* ( 1, k/
Agent or Applicant Printed Name Permit Officer's Printed
Signature '*'i`Please read compliance statement on back of permit Signature ' '✓
r,1Y‘ l`\' 64/p").'.� ) 2,i- i by• 762.1 _ f "Z- )�1.' _Zoe!
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(910-796-72 1 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 252-946-6481
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
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL DUALITY 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 1 and extends 20 feet
landward) is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes
maintaining diffused (non-channelized)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
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.
5. 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 Restoration: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 at a 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. j
• Pre-project site conditions: LA- i , f 1.7 Iawr•
7. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property
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 listed conditi and verify that all
information is complete and accurate.
floor V Jc 4e -...,
Agent ocApplic nt tinted Name Permit O icer's Signature
Agent or Applicant Signature Issue ate J3/ '
CAMA GENERAL PERMIT#: .7q 7-?,5
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington.NC 278891252-946-6481
Wilmington Office 127 Cardinal Drive FYI..W8ml.,grcn,NC 28405-3845! 010-796.7215
Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 1252-808-2808

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C ;1// Waa tr+:^^ 14-r:).\ 's
((Name of ProperF Owner)
property located at mot c k 1 Cree k) Pa rc e t b e 4e e-% S+K,+ t PA,-k 0
(Address, Lot, Block, Road, etc.)
on 3-ae.4.5 G r4ck in I/�a a • �� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X 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)
P r`o p o ? t 4,, r: - ,A e- b y N C N :,,,A y 3 2 ,
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.)
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
l'4i -Puf n4 v
Signature Signature*
A goal. Wckgrs C;41 df W es Gene Pittman
Print or Type Name Print or Type Name
YP Yp
p o 4 ok (488 1701 W. Fifth Street
Mailing Address Mailing Address
W4 14,, INC z `tT$°t Washington, NC 27889
City/State/Zip Cit /State/Zi
2s�• gH3-;/oSs�n,v4fu••t✓wasti�..,+ ;e• 252-623-5311p sgpittmanAncdot.gov
Telephone Number/email address Telephone Number/email address
57 13 lip z i 5/13/2021
Date Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature*

Washington City
Mayor • � Council
Donald R. SadlerC l t, y o/, Richard Brooks
��// Virginia Finnerty
City Manager hinton Elizabeth A. Kane
Jonathan Russell William Pitt
NORTH CAROLINA MikeRenn
May 12, 2021
Hand Delivered
N.C. Division of Coastal Management
Attn: Mr. Kelly Spivey
NCDEQ
943 Washington Square Mall
Washington,North Carolina 27889
Subject: City of Washington
Jack's Creek
Levee Repairs and Bridge Maintenance Project
Permit#26-20
Dear Mr. Spivey:
The Public Works Department of the Washington is requesting the variance to perform
work under the existing CAMA Permit 78-20 issued to the City of Washington. The levee at
Jack's Creek,which is instrumental in the prevention of flooding for the city and affords
effective Stormwater pumping,needs to be bolstered in several areas. The project will involve
fill in the form of riprap to re-establish damaged areas that are compromised due to damage
incurred during past storms. The project will also involve the repair of the sidewalk and
stormwater drainage at the Main Street Bridge. Per your direction, given the nature of our
maintenance projects and the current existing permit,we are obtaining adjacent property owners
consent to move forward with this important project.
We understand there is no fee associated with this project as we currently have an
existing valid permit. We hope this meets with your approval and if you should have any
questions regarding this permit maintenance request,please contact me at 252-943-8650.
Sincerely,
Wayne B ack,REM,REPA,CCA
Public Works Assistant Director
Enclosures/: Adjacent Property Owner's Consent Forms
102 East Second Street, Washington, North Carolina 27889
[phone]
www.washingtonnc.gov

Washington City
Mayor . z Council
Donald R. Sadler C 1ty)/ Richard Brooks
Virginia Finnerty
Walhi.naon City Manager Elizabeth A. Kane
Jonathan Russell William Pitt
NORTH CAROLINA MikeRenn
April 7, 2021
Hand Delivered
Caromex Properties Services, Inc.
220 Hugh Shelton Loop 102
Fayetteville,NC 28301
Subject: City of Washington
Jack's Creek Levee Repairs and Bridge Maintenance Project
Permit# 78-20
Dear Sir/Madam:
The City of Washington possesses an active permit from the N.C. Division of
Coastal Management to perform necessary maintenance and improvements at Havens
Gardens. The City is seeking to obtain a variance under this permit to perform necessary
maintenance and repairs to water adjacent structures. The levee at Jack's Creek, which is
instrumental in the prevention of flooding for the city and affords effective Stormwater
pumping, needs to be bolstered in several areas. The project will involve fill in the form
of rip-rap to re-establish damaged areas that are compromised due to damage incurred
during past storms. The project will also involve the repair of the sidewalk and
stormwater drainage at the Main Street Bridge.
Per the CAMA permitting process, we are forwarding you a copy of the adjacent
landowner's consent form and attachments. Your consent would only allow us to perform
the projects mentioned in this correspondence Please review the enclosed materials and
within thirty(30) days, submit any comments you may have on the proposed project to
the following address:
Division of Coastal Management
Washington Regional Office
943 Washington Square Mall
Washington,North Carolina 27889
Telephone: [phone]
No comment within 30 days of your receipt of this notice will be considered as no
objection.
I thank you for your time and if you should have any questions regarding this
letter or its attachments please contact me at 252-943-8650.
Sincerely,
Wayne Black, REM,REPA
Public Works,Asst. Director

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to City of Washington 's
(Name of Property Owner)
property located at Jack' Creek, Parcel between Main Street and Park Drive
(Address, Lot, Block, Road, etc.)
on Jack's Creek , in Washington , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to ac� tipn.
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)
Performance of work under the City of Washington's existing DEQ and Coastal
Management Commission Permit# 78-20. Due to compromised integrity, The City of
Washington proposes to repair/replace areas of the levee that work in support of flood
protection for the City's infrastructure. Subsequently repair work shall also be performed to
the sidewalk and Stormwater drainage system at the Main Street Bridge. The work areas are
it
highlighted on the attached GIS print.
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.
(Property Owner Information) (Ad c Property Owner Information)
_ 1
Signature Signal Q�t t-5k 0A-ATAi)
City of Washington CARO MANAGEMENT SERVICES INC
Print or Type Name Print o ype Name
PO Box 1988 220 H H SHELTON LOOP 102
Mailing Address Mailing Address
Washington, NC 27889 Fayetteville, NC 28301
City/State/Zip City/State/Zip
252-943-8650/[e-mail] N/A CCLO ? fb r{
Telephone Number/email address Telephone Number/email address
S• -.1I LC1) Pam.LL -K 2( c�tt a (v Gtto 4 p L (�Lt4
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

t;ERTIFIED MAIL® RECEIPT Washington City
ra Domestic Mail Only
co Council
ru • For delivery information,visit our website at www.usps.com"..
.� Richard Brooks
`n F F I I rr"r1 • Virginia Finnerty
fi_I Certified Mall Fee •
$ �O 11.1. O Elizabeth A. Kane
Extra Services 8 Fees(check box,add ttpropnate)
William Pitt
0 Return Receipt(hardwpy) s 2 T H CAROLINA
0 Return Receipt(electronic) $ As Apt •� st mark Mike R e n n
❑Certified Mail Restricted Delivery S a ? /O•�f��i
Q ❑Adult Signature Required $ G C/
❑Adult Signature Restricted Delivery$
Postage
$ April 12, 2021 C
Total Postage and FeeaipyO S
Se To 5 2811
RI
N
sf and i.>vo.its+ �(5-
�a,ip+,•�►L. ezh 113
PS Form 3800,April 2015 PSN 7530 02 .,o4I See Reverse for Instructions
. ,
Wilson,NC 27893
Subject: City of Washington
Jack's Creek
Levee Repairs and Bridge Maintenance Project
Permit#26-20
Dear Sir/Madam:
The City of Washington possesses an active permit from the N.C. Division of
Coastal Management to perform necessary maintenance and improvements to Stewart
Parkway. The City is seeking to obtain a variance under this permit to perform necessary
maintenance and repairs to water adjacent structures. The levee at Jack's Creek, which is
instrumental in the prevention of flooding for the city and affords effective Stormwater
pumping,needs to be bolstered in several areas. The project will involve fill in the form
of rip-rap to re-establish damaged areas that are compromised due to damage incurred
during past storms. The project will also involve the repair of the sidewalk and
stormwater drainage at the Main Street Bridge.
Per the CAMA permitting process,we are forwarding you a copy of the adjacent
landowner's consent form and attachments. Your consent would only allow us to perform
the projects mentioned in this correspondence Please review the enclosed materials and
within ten(10) days, submit any comments you may have on the proposed project to the
following address: Division of Coastal Management
Washington Regional Office
943 Washington Square Mall
Washington,North Carolina 27889
Telephone: [phone]
No comment within 10 days of your receipt of this notice will be considered as no
objection.
I thank you for your time and assistance. If you should have any questions
regarding this letter or its attachments please contact me at 252-943-8650.
Sincerely,
Wayne Black,REM,REPA
Public Works, Asst. Director

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Ut. aA WASk,�•S1'am
Address of Property: sus Cesal Po.fc4.1 (314 nt.... S+r.e.� P4,-1( 1.4,,.c)
(Lot or Street#, Street or Road, City &County)
Agent's Name#:Y'IAynt-B61.(G i1 4 VNsL1QMailing Address: P.a. B a s► 19g8
Agent's phone#: 2%.L. qv 3 - F654 Vries��. V•w ►JIL X1vfy
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 proposing. A description or drawing,with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagement.net/web/cm/staff-listinq or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
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
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.
(Property Owner Information) (Riparian Property Owner Information)
Signature CAW Signature
Gay 41 AixL'SNctLN CAms6J r.
Print or Type Name J Print or Type Name
P.6. a•t1%* P.o. BotSrISj
Mailing Address Mailing Address
`••,,4 Nc.. 11.1$ems, NC 3.1?9I
City/State/Zip ' City/State/Zip
C1.943-F .coj�r61Acta s�• .mmt• lab;
Telephone Number Email Address Telephone Number/Email Address
'n- 2.l
Date Date
(Revised Aug. 2014)

k......' — :
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A. Signature
• Print your name and address on the reverse X 0 Agent
so that we can return the card to you. 0 Addressee
■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? 0 Yes
p ,
Gags�t I r� ►NA Nils r0 A If YES,enter delivery address below: El No
s
P.O, 6dy gi s5
V.1sa(", .1.C.. 119ia
1 I I' III
111111111
IIII'1I I II'II III(I I III 3. Service Type Priority Mail Express®
0
0 Adult Signature Registered Mailr•
❑Adult Signature Restricted Delivery 0 Registered Mail Restricted
9590 9402 6051 0125 9132 65 II Certified Mail® Delivery
o Certified Mail Restricted Delivery ❑Returnurn Receipt for
❑Collect on Delivery Merchandise
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