79419A_Butler, Joseph_20210827

REC NED
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM AUG 2 4 2021
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: : '
Address of Property:
Mailing Address of OWnE
9, t�U-T,
DCM-EC
Owner's email: SA 40AP 1 ;4 0 (& Owner's Phone#: (�ZE7) 4e�' l ! -,334OY
AsW&me: Agent-PtiVb_ne#:
Ag Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
7 f,32
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 drawina. with dimensions. must be Drovided 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. 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
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:
Typed/Printed name of ARPO:_..L)odu , R�"7LCARP-c- T 1
Mailing Address of`ARPO:4r7ZS iiPwQ.LS ecx.4r �AO, V�Rf�'��� (&� A, N[A 234955
ARP)GC. A�f2T Mall .GoN� IS 1 r_i 7'C+t7�j9
e ail: +� P q ARPO's Phone#: (U
Date: at )u5� % �2 .*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

RECEIVEL
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM AUG 2 4 2021
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top p—ortrti'onn to be completed by owner or their agent) DCM-EC
Name of Property Owner: --.J
Address of Property:
Mailing Address of Owner:
Owner's email:S{,61�/�-'1 / �`JI 1 Owner's Phone#: �'
Age�me: " T Age�h ne#
AgepV-5-Cmail.
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 forthis
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
`F 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. 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 15from 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
�rgnarure or Hnlacenr rapanan rroperry owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
'11, _ n,
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: PC E),/41?;rs -).d t---ARPO's Phone#: ( �1 �� � 1(v
Date: �1 2Z21 *waiver is valid for up to one year from ARPO's Signature*
�nL, rra,waatd
use t4r—
Revised May 2021

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CHOWAN RIVIA _
Bp 1I40
SITE
BR 1I\7
SITE MAP
LEGEND:
It ... OENTBRLINt
IRS ... IRON ROD SIT
BR ... Ex UTING IRON PIPE
■IR ... Ex ISTINO IRON ROD
RIW ... RIGHT OF WRY
(0) ... OONTROL
CM0WXt4 RIVER
N 44 Of 00 L 20.00'
101.01' Pu 101.40' Re 11.00,
f � 7.00' i1
E
PN
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1.16 ACRES
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1.01 ACRES
0.94 ACRE
MANOR N
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14b.27'
Re
101.70, RE
— 3 41 00,00, Y 101.14'
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101.70' BIE
SURVEY FOR
JEANETTE H. DOWD
BANDON ROAD
SECOND TOWNSHIP, CHOWAN COUNTY
NORTH CAROLINA
REFERENCE: DEED BOCK 18, PAC! IO
MAP BOOK I, PAN I
DEED BOOK 180, PAN ISI
WALL• 1 INCH . EO FHT OOTOW EOOA
w D w w or
MARK D. PRUDEN Il WRVIYOR L40I1
10 OAK GROVE ROAD, MXNTOK NO SMI
I CERTIFY THAT THIS S BY AN NXOBPTION TO THE SUBDIVISION ROLL
3.10 ACRES TOTAL
BY COORDINATES
RECDVD
AUG 2 4 2021
DCM-EC
MI'm for Rcaq I Ju lilo oftlea r1:i,. '
9q;An'u ^tar.^.•,.,; .. �.. ;;. - a
Y.
6TA72 OF NORTH CAROLINA • ONOWAN COUNTY
L MAW 0. PNWrI, OBRTIFY TWAT THIS NO WAS DRAWN BY M OR UNDER MY MRMVWION
PROM ULEI BE�OODIIEB—OIiId�T_10_N_RBOO—
ROBD M
O_—EII—WZE_IQN—IV�IMDIY
ODED0POAIIGE{EMII
RBYATPAGE OAEINOTELM w--__—
TWAT THE BMDI Q OLCEUNf AS OALOYLATEY O EY LAYMUOU AND DMalTUNE
11 _�J
THAT TIIB BOUIOARIBe NOT BWIVEYEO An SHOWN AE mom Lou ROTTED PKOIA NPDINATKIII
$Tr,Tli. OF NORTH CAROLINA
POUND IN DBED BOOK _______ PAW --_ NAP BOOK --_----
COUNTY OF CHOWAN
MOB ----_—_ PLAT OAKWT
I, OWL M, Kr,HEHAND, Revlew MOO. Ot
THAT TIN MAP WAS P AMD N ADCOIIDANOB WITH al ♦7J0 M
CHOWAN County,tho mep or plat
wrtrwu MV NAND AND uu nN _DAY or d: �x __ `AGZ_
whlph IIIIa ,,bin le attl%atl n;nele
ell ewutay iaVuirnms to IDr rscmtlin
of
,::l
`/�//--
—L•NN
iff GAIL M, FOREHAND
wwvEYDR IIBa NO.
ReYlew Officer
DAYE:��

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