79392A_Sheil, Peter & Jennifer_20210804

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h,dGENERAL *+ PERMIT Preosn�4
X New Modtficauon -- C.er V-Cte P.ass.,e Partial RetSsue bite prreous permit
As a,-u%onted tyy the Smote of North CarohrA. of Erv,rorrwvol Qmkty 11 H - is Co
and the Coxzat Resc+.-ces Coayr,*uon ,n r area c/ er-rro vrw-o� come-r pOWL-K to 1 SANC.AC ---
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Phone O ,51_1) _331 " ISSZ E-Mai (�.Subdms on___ --SG
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Affected OEA - trt}i _ tN C USA � WA
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Notesi Special Condtions
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
C=RTIFED "I� - RETURN RLUIPT RFOUESTMor HANl ) �01=251
(Top portion to be completed by owner or their agent)
t lic of Property Owner Pete and Jcn Shed
Aedress of Property, 1. 0 1 Q Swg§
MitIng Address of C)wner. Sam, as &oav-
Own,er`svnxl
Aoer*, s Mamma , WA Agent PtvorvM—NIA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiseent Property QwwJ
Tf -;;;; —Iwvc abjec'b' w--="-to —whwis being­prop'osed, you must notify dw , N.C. Derision of Coa - z , W
Management (DCM) in writing within 10 days of receipt of this notice. Cwrespoodenco should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC. 27909. 0CM representatives can also be
contacted at (25212"3901. No response is considered the same as no objection if you have been
nottlied by Certified Mail.
WAIVER SECTION
I i,,nderstand Matany proposed pier, dock. mounng piLngs, boat Mmo, bfoakwalet, ooatm;se, lift, of
grom must be set Wck a ffuntmurn distance of I b* from my area of rp.vian occess unless wwved by me
tum docs not apph to bukheads or rgirup revetments) (if you wish to wa". Ibe sezacx, you must sign
the appmoroto blank bc;a*
100 wish to wan'e sometall of the IT net k
7/01-1
swave of firRi(partan l7roperry (Nvft-t
on- / / I/ ,/'
I do not,.wsh to ww" the 15' setback "r ment (iftal the b4ank)
Sqnxuru of Adjacent Riparon Ptopetty Owner-- Z�l zi e-
Typedlftnted nzma of ARPO:
Wiling Address of ARPO- e/7
ARPO*semzil: 4'e/f*/`4­"4//"I,,.,.:-.+<.--*ARPO'sPhonebI
Al I e
Date:-- aiver ts valid for up to one y0ar from ARPas Sign3tum*
Revised May 2021
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N.C. DWISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION MAIVER FORNI
CERTIFIED MAIL RETURN RECE,10T REOUES7D or DaIVERY
(Top portion to be completed by owner or their ager.-i
Address of Propefly 10 10 and SrxTe Or E derttor, N Q 27912
Ma�l,.ng Adcressof Owner Sarre as aocve
Owner s ema,l Bluemount3s-rimagtcgWail Com Owners Phone# [phone]
Aaent r, Name N/A Agent Pt*ne# NiA
Agents Email WA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portim to be completed by the Adjacent Property Owner
I hereby certify ttat I own pf operty adjacen! to the al ove referenced Property Tbe ondmdual applying for ttlits
perrnft has described to me, as shown on Me attached drawing the development they are proposing A
I CO NOT haire objections to this proposal I DO have oblectiians to this proposal
tf ysau have objections to— what is being proposed, you must notify the N-C. n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice- Correspondence should be
mailed to 401 S, Gritfin St., Ste. 300, Elizabeth City, NC, 27W9, DCM representatives can also be
contacted at [phone]. No response is considered the same as no objectiort d you have been
notified by Certified Mail.
WAIVER SECTION
I Lofderstarcl thW any proposed pier dock Mooring pilings boat tamp breakwatef bcattiouse, 1&, or
grown mast be set back a minirrurri distance of 15 from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revelments) (If you wish tohaive the settack you must sicln
L+,e appr W-Late blar* Wcr* 'I
I DO wish to warve sorriefall of the 15' setback
Sr .rare Aq,L �,�iparjan Property Outer
_OW 17
I do not wish to waive the 15'serback requweenent (initial the blank;
Signature of Adjacent Riparian Property Owner
TypedfPrinted name of ARPO,
Mailing Address of ARPO�
ARPO*s email - ------------ ilr �4�WRP16^one#: Z - 131_:��477
Date: -waiver is valid for up to one year fTOni ARPO's Signature*
Revised May 2021

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