79853_Mary Litchfield_20210727

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1111 El CAMA I. Q DREDGE StFILL # Qk` S N9 79853 A 1 C D
GENERAL PERMIT �O Previous permit# 1\J/1.4
)Z ❑IIew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued r.) /A
As authorized by the State of North Carolina,Department of Environmental Quality i
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC (�) 4')-1 • -0O .1 .x Rules attaached.
Applicant.Name ( �6� l/i P"r � i Project Location: County �q c..-t-P r-4 t",n ,
Address f l) . 1` ( x c!(0 / Street Address/State Road/Lot#(s) ('.�j "'=• (? t,cf�'
City A-tA , () State/\S ZIP 18 69 PI-(k�30-,/ 17-1- • ig() - -4 f41 /,4,,chi i! - 2
Phone#(267) ,z,:t..- °�" oticE-Mail) — /�? Subdivision Nni .
• Authorized Agent 4- -•
f1 a ),„it : 1),v in o Lb ri c f- City 41AYII I'A . . 1�rI�/ ZIP • 9 'rS�,f:'(t^ .�f
❑CW ,p EW I PTA ❑ES ❑PTS Phone# (TV-) ,2.t %tl'7 7 River Basin�4K / J•''i r r 2
b
Affected ❑OEA ❑HHF ❑IN ❑UBA ❑N/A L , f
AEC(s): Adj.Wtr. Body 'p-.t ,'^�'(�'t. C(natVman /unkn)
❑PWS:
Closest Maj.Wtr. Body' '(CA YrN, i l `� 7?i '-'"
pRW: yes /0 PNA yes /C,
/ 1
Type of Project/Activity s-/ *74// -�'X I V i l(Y 4-'/iy4+ 2O y Z c� -' .A=,m/>
.14:1 or Pr►'' 6C I l ev, ` ))r'ti / V i'N- Y (Scale: 0,' )
a f r •
Pier(dock)length s 90
Fixed Platform(s) 1
i 1 I 1 ; ;:> a." t. v'1 t''F:` 1'..1
i
Floating Platform(s) _ / E 1111111111111.11 _ 11111111111111111 NI N. ___i� E n4-
t
Finger pier(s) 1 _ w .ILliTr MI ' 1
! _.
Groin dengtli
number .__ ... 4���j 11111 I
}
Bulkhead/Riprap length 1 . h - - ± ! ___1_
avg distance offshore i �� U� I' a _
max distance offshore , I j 1 r: If
Basin, I channel i , ,
summummu
cubic yards ■ R• ._ i U■R1' N I — 1 ■■■■ ,
Boat ramp ' � � 1 1 , 1 , I
. , ,
' i I , i f
Boathouse/Boatlift .11 —1 —� •
I
Beach Bulldozing / —.
Other i 111111 ! �� i 1lUll : I
U�SSHIMPIN i N.� ���
Shoreline Length it j • i / 1 : ' ,
not sure • I —'----
SAV: yes- no -� --„--� s. ,. � -- --� __I__ — __ _..,...,�-�.
f
Moratorium: n/a yes a t 9, j 1
Photos: yes no ' ; _,..;o.l _ _.—_ ; .._ _ t' i`` t_-
Waiver Attached: yes no . q4" IA-
A building permit ma lie required by: J 'Gi/4- !'it eU• . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) I , . • I J
Notes/Special Conditions 1�. ` I G PIN l in 0 l^^r U i��kill WI L. t" r t`' +r'(CS•
h p 4+44 LIPD 2 i (-;)f
Agent or Applicant Printed Name PermitOffAcer's4Printed Name /' i
i f 1j �,� i J ,w„r'
Signa ._
ture **Please read compliance statement on back of permit** Signature „ ,i, _
rli
_i; ..0,.0,0.2
Application,Fee(s) 1 Check# • Issuing Date) ti 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 fl 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 0-796-7215)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
40I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-390I Fax: 9 I 0-395-3964
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

. , .
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. .
ekElARAI .A 0 DREDGE 8c FILL t,- „4., • ' -,
, --'55)*6°1 Ot'1S 3 N9 79853
, . A Z C D
GENERAL PERMIT . PreVious permit# ' NIA
>------7-'-'ONew EModification litoMplete Reissue OPartial Reissue ' Date previous permit issued pi h A
As authorized by the State of North Carolina, Department of Environmental Quality • • ,
and the Coastal Resources Commission man area of environmental concern pursuant to.I SA NCAC r-, -,41 ,.
' J ) , ,I A Rules attached.
Applicant Name /1)41.v /1„ 17(kr) 'Cli'T,:-.. i t) A ,-
, Project. Location: County EThert LA-Pt: v- , t 1:23 ,
...-•::::), .....; ,,
0?/6) . • •
Address i . (_.>• 1-,(` ..,X , Street Address/State)4 Road/Lot#(s) c'• 1-- Fr; s'i? )cy r,..
r'''''..I..)7' 1 1
City 4 ttorp (ht N
.. - . State C- ZIP( 1807 4,.. . • Pt.(kk,ti f - h.- - 1,u, 15,/,;/.1 ,/,.1 e I,j,14--(11 -41,1?
Phone#(2.S.. ) 7-1.-2-7 -4;i1pt./(IE-Mail '-----------r) ' Subdivision
Al. v
Authorized Ag9nt 1.4 r )I,VA 1 i /i V.kYlo i Lc)II'S* ' City f,-lAY7,(a ZIP
0 cw, )X,EW XPTA CI ES El PTS ' . Phone# (7<t-)_;':2.Z'7 S/01/9 River Basin-r/qt.".pa ril'
Affected. . . .
AEC(s):• 00EA,, CI HHF 0 IH E UBA CI N/A
. Adj.Wtr. Body <-)f-,....L,A
' . " t I_ ( ,9 e k..- (Iiikklman /unkn)
0 PWS:
72"-
ORW: yes / IG PNA yes - I
Closest Maj.Wtr. Body " rrl i (." i<-7 i ‘-'-'-'1,"
.D.O /(,)
. ,/_,,i') / / i • ,
Type of Project/Activity _<! sr)541/1/ 70 Y W V trr . 41,/171Z 2 6 Y 7 0/ .T-- A 7--,A
d_ . , ,
1 A '47.)0 Y.12(i L°.(''' tY(7 .6)/';')')'14' '''.7))Ce.r li . T-Y-1:2/) ''';...-1 40
e"
Pier(dock)length & XC-1D/ (Scale: I j) -
ir
.., 1 1 1 1
4
Fixed Platform(s) 7,17.)''')( , _ womiammiimom , i : iim1limaimmuni
Floating Platform(s) '1 ; I—1 IIIIIIIIIII II ' ' __:_! MP NE ) : i 1 L.:noon ••,--__;--._ir-t- !
1
Finger pier(s) / : 1 1.._ J 1 , J 1 "1 In. , ; 1 1 1 i-1...
Groin length i ' 1 nr I---- i,"- -1 . i'. I-110' i:---1/4. if-' -F-!---7---T
, number i ' '
IIi :; ' • ia-(14: I ; i . ; • •;,„1• ;
Bulkhead/Riprap length/ ..
1111r1 i' ; IIII i. it— 1 i I 1111 '1 : •,;1 f
avg distance offshore 111111111.11111. --r - ' III —I— 71 ' I IIIIII 1 i- i 1 '..
max distance offshlore ; I . ; • ,,„, •
Basin,channel 1 1
" , 1111111lOU ' 1 : • r
, &
11111
t ' / I 1 lik:: 1 • '4. ; .
11111111111111111111 I isumgoicesimar nit ,I A MINIM musion
cubic yards ' Nimi an f'"- ' -
' Mi. ,.....3. ot . . , as ,.. ... I 1 .
- Boat ramp • ' 1
111.10' ' I I ! I
•Boathouse/Boatlift
1• Or : I '.
-t---1— :
• 1 :
— --- --'-- ,---;
Beach Bulldozing i
i• III _ ;
- Other / 1 HUH :
I, , , .
-- .. .. ,, , .... ____,___,__ _
, , , __
. , , . i , . ,,,, . . ,
, .. „ „
, , . IN I ..t.ovot.l. [
1 Ni ..,1,- ; !
, IMIIIMIL, 1111Pril ,--5r, ,; ,t -',. ,, .-.4, . 1
' Shoreline Length -.1- ic-0; 1 -
'''"- •1 • : :
; 1
MWM 4 III :, i , 1 i
SAV: not sure yes no- : --,- -i -,,•:',-/-;" ; ; --''.1 , -A'
1_Net.••• ;
•=r,,,,k,'--.:-:.:---- --- /....1.1,1;:;:c,, rsi- , -1-- ‘li , , is‘IP : i -7- . ' . , lric',); i.--":(.--i;
Moratorium: =n/a yes no ; :i=1: ' : : 1 : _J
Photos: yes no . ; _ : p• ,... ; ; I :7t1-
-i- ,
Waiver Attached: f:s ..---n o v I -14."'1,-Iii.1 • , , . , 1 1 1 i .-
ey ,
•1-
A building permit may1:ier'iretq''' _
uired by: (-':-.;".1/4-4't L... 6. .. lee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) . (1
Notes/Special Conditions brrir 1 Mill`)1A10114f--) I 0 kj 14 IA1(+1. '.i, tf14) +KIPC.‹. _
\10 4 tnii I ej Tx 1+1,1 re , oW , IVDD 4,f , ob)71e. ,- , 4,-0 i
, .
,ev; c.)-4- 1 /94.,/keie.,,) a 4,-/i. .
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(,I, LA. - . i. . 1,..\\ ,,,,,
,
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e.\/ (...Qe ao ay . .
Agent or Applicant Printed NSme ..
.
' , Permit Of -printed Name
f..
'(.....' ,
Signature : **Plgase read compliance statement on back of permit**, Signature 1J •
17C) 2-f 'OD I..°-2
'
...._ —
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 n 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(9 I 0-796-72 15)for more information on how to complywith 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: 9 I 0-395-3964
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
a Governor
MICHAEL S. REGAN
A Secretary
Coastal Management BRAXTON. DAVIS
ENVIRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 & .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. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
O Pre-pro' ct site conditions: Zoe / s �j'&.-It ca /dA 6.--7
w- a 4w f>--<„
By your signature below you agree to be held responsible for meeting all of the conditions listed above an v ify
that all information provided is complete and accurate.
•
Age t or Applicant Praited Name P it Off' is Si ature
ni\y
•
l / / 0.?c,, az32.]
Agent or Applicant Signature pe Date/
CAMA GENERAL PERMIT#: Tigt-5;
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington;NC 27889 1252-946-6481
• Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-3845I 910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City,NC 28557 1252-808-2808

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Cacetuut
Address of Property: p( Ce;-€.4-. q' 7
Mailing Address of Owner: p\d $, 'tee . 91C ,0177.,SW
Owner's email: Owner's Phone#: 32 Z-
Agent's Name: .tfiget x-+.X-P Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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.
r I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at(252) 946-6481. No response is considered the same as no objection if you have been "
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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 (this
does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below.)
PCs 7 1405 PAA-ram coiv‘PFl.,�y
I DO wish to waive some/all of the 15' setback
Signat a of Adjacent Riparian Property Owner
-OR-
1 do not wish to waive the 1'5' setback requirement(initial the blank)
? p 4 1-1 fe1 E A'J
CO"'
' , .tivG.
Signature of Adjacent Riparian Property Owner: y
Typed/Printed name of ARPO: ,J�,H►-, $. e 5r— i l
Mailing Address of ARPO: PO- 130)( L V , !'IUR.n 4: NC- 42.76'6 r
ARPO's email:john-Fre 7r@ P)/.cool ARPO's Phone#: ASJ.- 3.9a-S17-1
Date:(77j'A/Jar.0...) *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed.development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts(showing delivery of notice)are needed,or any other method which satisfies the Local Permit Officer
(LPO) that a good faith effort has been made to provide notice.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments(or potentially object to)the proposed development,and
to give DCM or the LPO an opportunity to consider these comments/objections before a permit decision is
made. "Permission" of adjacent property owners is not necessarily required for DCM to issue a permit;
however, permission must be obtained for certain types of proposed developments if they fall within a 15'
setback area along the riparian access area of the adjacent property, as determined solely by DCM. It is in the
applicant's best interest to provide comprehensive and accurate notice so that any concerns or objections can
be resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
. permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
•
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street-ends which might be used for parking and beach access.
• • Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent proPerty legally intersect with the water at'mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.qov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the proposed
development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel and
we will work to answer your questions.
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: 11/1.,y4 .. 420.1iti e a nn i,
Address of Property: )cf��,het� esT�,�� �Kc/ - (.2
Mailing Address of Owner: p() f3d a /co : 6 2,-e , r� ii C 2 7 2-06
Owner's email: `7\ Owner's Phone#: 02 ,v
Agent's Name: j� ��tcX� Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division. of Coastal
Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at(252) 946-6481. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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 (this
does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15' setback/7/2 -/ )(-0706w
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner: % 7€ .-(i
Typed/Printed name of ARPO: f L 4 / s Ho yJ y�
ofARPO: (-'/!�I2Uy y � l�V Y0 y 2- '
Mailing Address �0 v� � ��' / � .
ARPO's email: ARPO's Phone#: ' 3 2 `t 3-ci
Date: d 7�z//..°z/ *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts(showing delivery of notice)are needed,or any other method which satisfies the Local Permit Officer
(LPO) that a good faith effort has been made to provide notice.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments(or potentially object to)the proposed development,and
to give DCM or the LPO an opportunity to consider these comments/objections before a permit decision is
made. "Permission" of adjacent property owners is not necessarily required for DCM to issue a permit;
however, permission must be obtained for certain types of proposed developments if they fall within a 15'
setback area along the riparian access area of the adjacent property,as determined solely by DCM. It is in the
applicant's best interest to provide comprehensive and accurate notice so that any concerns or objections can
be resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• • A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin. -
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street-ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian? •
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.qov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
•
What is Notice, and how do I ensure it is received? -
• You can meet with your adjacent property owner, provide a description or drawing of the proposed
development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions.about this process, please reach out to DCM Staff and DCM Legal Counsel and
we will work to answer your questions.
•
Revised May 2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: A ,d ,!e A/42_4PMailing Address: c14 'j9 X . ,PG
Phone Number: 409 ,2 ce yr cf
Email Address:
I certify that I have authorized Q 4•
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: lip r
at my property located at 7O/�eA ( � .
in � , � County.
1 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 revaluating information related to this
permit application.
Property Owner Information:
4"914_,
Sig atur
1 s. M ORy i xQ lam71h 1,.. ill eld
Print or Type Name
Title
1 1 „0,2/
Date
This certification is valid through I I