78026A_NCDOT_20210311

..
L
0;t�0.'AMA / 1-1DREDGE & FILL N9 78026 A B C D
ENERAL PERMIT Previous permit# -
ew ❑Modification ❑Complete Reissue El 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 15A NCAC %
❑ Rules attached.
Applicant Name NG Y Project Location: County D&P_.
Address j 1 Air-f74x:, F-9• . S1-1 ITE '100 Street Address/ State Road/ Lot #(s)�f, )A)(,,
CityF OF —Tom State ZIP �� '�u'' ivr`I E u1 ccri Pj 7' . `.0 to ` 5.
Phone # E-Mail a�f /� ` ' ` /; Subdivision �l
Authorized Agent ; *': ! !�' J '`�' v�'w' City <ITT-, r1�� ZIP '7q`tq
Affected ❑ CW ❑'EW ❑ PTA SAS ❑ PTS ` Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body K ' 1 --i iAAU L EA )
ElPWS. nax /man /unkn
now• e� i ,,,, ante ,.oc ieRi Closest Maj. Wtr. Body a� -'O
Beach Bulldozing
Other
Shoreline Length S��
SAV: not sure yes Q°}
Moratorium: n/a yes tno
Photos: yesJ no -- 1....._f....... �—
f
Waiver Attached: yes t
A building permit may be required by: Qr,lc.r_
( Note Local Planning jurisdiction) ,,ii
Notes/Special Conditions,,I�� =T�1�,,,� MkfF'', ��i/�ll g� FAG F&�
I'.n 1 y f Vr Cu
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
t* q
Application Fee(s)on Fee(s) Check #
❑ See note on back regarding River Basin rules.
L
(' +
Permit Officer's Printed Name
Signature
7 X, ='1
Issui g baiV Expiry on D e
Ja

u
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 1) 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/ 1-888ARCOAST 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
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

. •
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
3 March 2021
Mr. Greg Daisey
Projects Field Representative
North Carolina Division of Coastal Management
401 South Griffin Street Suite 300
Elizabeth City, North Carolina 27909
Dear Mr. Daisey:
J. ERIC BOYETTE
SECRETARY
The North Carolina Department of Transportation (NCDOT) is requesting the issuance of a GP
.1100 for the stabilization of the SR 1216 Moore Shore road shoulder adjacent Kitty Hawk Bay in
Dare County, North Carolina. Erosion is flanking the north and south ends of the existing riprap.
A total of 50' of bank will be stabilized (25' on either end of existing revetment) with a class B or
larger granite riprap within the right of way for SR 1216. I am available to meet with you to stake
the alignment per the attached drawing and obtain the necessary CAMA General permit.
Included with this letter are the location map, permit drawing, MP-1 and MP-2 forms and proof of
adjacent property owner notification. If you have any questions, please contact me at (252) 402-
4015. The $400 permit fee can be charged to WBS No. 1.1028111.
Sincerely,
Sterling Baker, P.E.
wineern
ivi
Stee
e;ll
Division One Environmental Specialist II
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DIVISION ONE
113 AIRPORT DRIVE, SUITE 100
EDENTON, NC 27932
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-3684968
Website: www.ncdot.gov
Location:
113 AIRPORT DRIVE, SUITE 100
EDENTON, NC 27932

N
Shoreline Stabilization - Repair/Maintenance
SR 1216 Moor Shore Road W
Dare County Quad Name Kitty Hawk S
WBS# 1.2028111
200 100 0 200 Feet

Ron rr-1
APPLICATION for
Major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant(Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
SR 1216 Moore Shore Road Shoreline Stabilization
Applicant 1: First Name
Stevel
MI
J
Last Name
Trowell
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
113 Airport Raod
PO Box
City
Edenton
State
NC
ZIP
27932
Country
USA
Phone No.
252 - 482 -
1876 ext.
FAX No.
252 - 482 - 8722
Street Address (if different from above)
City
7
State
ZIP
Email
[e-mail]
2. Agent/Contractor Information
Business Name
Agent/ Contractor 1: First Name
MI
Last Name
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
PO Box
City
7-
State
ZIP
Phone No. 1
ext.
Phone No. 2
ext.
FAX No.
Contractor #
Street Address (if different from above)
City
State
ZIP
Email
<Form continues on back>
252-808-2808 .. 1-888-4RCOAST .. www.nccoastaimanagement.net

Form DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Dare
SR 1216 N 36.059345°, W-75.697467
SR 1216
Subdivision Name
City
State
Zip
N/A
Kitty Hawk
NC
27949 -
Phone No.
Lot No.(s) (if many, attach additional page with list)
- - ext.
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Pasquotank
Kitty Hawk Bay
c. Is the water body identified in (b) above, natural or manmade?
d. Name the closest major water body to the proposed project site.
®Natural ❑Manmade []Unknown
Pamlico Sound
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
®Yes ❑No
work falls within.
Kittiy Hawk
4. Site Description
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
250'
7,500 ft2
c. Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
4' ❑NHW or ®NWL
e. Vegetation on tract
Various roadside grasses on a maintained shoulder. The fringing spradic marsh is vegetated with Giant Cordgrass and
common reed.
f. Man-made features and uses now on tract
Existing riprap revetment and secondary road.
g. Identify and describe the existing land uses adjacent to the proposed project site.
Residential
h. How does local government zone the tract?
i. Is the proposed project consistent with the applicable zoning?
N/AI
(Attach zoning compliance certificate, if applicable)
❑Yes ❑No ®NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ®No ❑NA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No ❑NA
National Register listed or eligible property?
<Form continues on next page>
m. (i) Are there wetlands on the site? ®Yes ❑No
(ii) Are there coastal wetlands on the site? ®Yes [:]No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? ®Yes [:]No
(Attach documentation, if available)
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Form DCM MP-1 (Page 3 of 5)
APPLICATION for
n. Describe existing wastewater treatment facilities.
None
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems.
None
Major Development Permit
5. Activities and Impacts
a.
Will the project be for commercial, public, or private use?
❑Commercial ®Public/Government
❑Private/Community
b.
Give a brief description of purpose, use, and daily operations of the project when complete.
Road shoulder to be repaired and stabilized with granite riprap.
c.
Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
Granite riprap will be brought to the site to be placed by a rubber tire backhoe or tracked excavator. An adequate slope and
filter fabric will be in place prior to construction of the riprap revetment.
d.
List all development activities you propose.
Propose to stabilize an eroding road shoulder adjacent SR 1216. The new work will
be blended into the existing riprap
revetment.
e.
Are the proposed activities maintenance of an existing project, new work, or both?
Both
f.
What is the approximate total disturbed land area resulting from the proposed project?
500 ft2 ®Sq.Ft or ❑Acres
g.
Will the proposed project encroach on any public easement, public accessway or other area
❑Yes ®No DNA
that the public has established use of?
h.
Describe location and type of existing and proposed discharges to waters of the state.
Surface runoff from SR 1216.
i.
Will wastewater or stormwater be discharged into a wetland?
❑Yes ®No DNA
If yes, will this discharged water be of the same salinity as the receiving water?
❑Yes ❑No ®NA
j.
Is there any mitigation proposed?
❑Yes ®No DNA
If yes, attach a mitigation proposal.
<Form continues on back>
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) — (0 are always applicable to any major development application. Please consult the application
instruction booklet on how to properly prepare the required items below.
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
252-808-2808 .. 1-888-4RCOAST .. www.nccoastaImanagement.net

Form DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
Name Lucille Stokes
Phone No. [phone]
Address 408 Beacon Drive, Kitty Hawk, NC 27949
Name Roebuck Properties LLC
Phone No. [phone]
Address 4025 Windflower Lane, Raleigh, NC 27612
Name Amy Wells
Phone No. [phone]
Address 3749 Herbert Perry Road, Kitty Hawk, NC 27949
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
h. Signed consultant or agent authorization form, if applicable.
I. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
7. Certification and Permission to Enter on Land
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date 3 March 2021 Print Name Steve T visio Environme K1,1 cialist II
Signature
Please indicate application attachments pertaining to your proposed project.
®DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges and Culverts
❑DCM MP-3 Upland Development
❑DCM MP-4 Structures Information
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement. not

Form DCM MP-1 (Page 5 of 5)
APPLICATION for
Major Development Permit
252-808-2808 .. 1-888-4RCOAST .; www.nccoastalmanagement.net

Form DCM MP-2
EXCAVATION and FILL
(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet.
Access
Other
Channel
(NLW or
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
(excluding
Breakwater
shoreline
NWL)
stabilization
Length
Width
Avg. Existing
Depth
NA
NA
Final Project
Depth
NA
NA
1. EXCAVATION ®This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards.
C. (i) Does the area to be excavated include coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
OWL []None
(ii) Describe the purpose of the excavation in these areas:
d. High -ground excavation in cubic yards.
2. DISPOSAL OF EXCAVATED MATERIAL ®This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
C. (i) Do you claim title to disposal area?
❑Yes ❑No ❑NA
(ii) If no, attach a letter granting permission from the owner
e. (i) Does the disposal area include any coastal wetlands/marsh
(CW), submerged aquatic vegetation (SAV), shell bottom (SIB),
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of disposal in these areas:
d. (i) Will a disposal area be available for future maintenance?
❑Yes ❑No ❑NA
(ii) If yes, where?
(i) Does the disposal include any area in the water?
❑Yes ❑No ❑NA
(ii) If yes, how much water area is affected?
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimananoment.net revised: 12/26/06

Form DCM MP-2 (Excavation and Fill, Page 2 of 2)
3. SHORELINE STABILIZATION ❑This section not applicable
(If development is a wood groin, use MP-4 — Structures)
a. Tvbe of shoreline stabilization: In I ennth- sn-
❑Bulkhead ®Riprap ❑Breakwater/Sill ❑Other: Width: 10'
c. Average distance waterward of NHW or NWL: 3' d. Maximum distance waterward of NHW or NWL: 5'
e. Type of stabilization material:
Class II and "B" rip rap
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap 75 ft2
Breakwater/Sill Other
i. Source of fill material.
quarry
f. (i) Has there been shoreline erosion during preceding 12
months?
®Yes []No ❑NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
2'-3' from field observations.
h. Type of fill material.
riprap
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? ❑Yes ®No ❑NA b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ❑None
(ii) Describe the purpose of the fill in these areas:
15. GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhoe, or hydraulic dredge)?
Using NCDOT Best Management Practices for soil and erosion tracked excavator, backhoe, dumptruck
control.
c. (i) Will navigational aids be required as a result of the project? d.
❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
3 March 2021
Date
SR 1216 Moorshore Rd shoulder stabilization
Project Name
Steve Trowell, Environmental Specialist II
(i) Will wetlands be crossed in transporting equipment to project
site? ❑Yes ®No ❑NA
(ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
plic
plicant Signature
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized agent:
Mr. Steve Trowell, NC Department of Transportation, 13 Airport Drive Suite 100, Edenton, NC 27932 Phone no. [phone]
Authorized Agent's Signature Date
Name of Individual Applying For Permit: Steve Trowel) agent for NCDOT
Address of Property: SR 1216 Mooreshore Road adjacent Kitty Hawk Bay
(Lot or Street #, Street or Road)
Town of Kitty Hawk, Dare County
(City and County)
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, should/be provided with this letter.
r/ I have no objections to this proposal.
I object to the project as proposed.
If you have objections to what is being proposed, please send written objections to Ronald Renaldy District
Manager, Division of Coastal Management, 401 S. Griffin Street, Suite 300, Elizabeth City, NC 27909 within 10
days of receipt of this notice. 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, jetties, breakwater, boat house or boat 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.
do of wish to waive the 15' le ack requirement.
=Lui
e to
. Stokes,007
Jr Print Name
S us A 111 i(/ %_o //Es � C
Telephone Number with Area Code
�j11VAVA
0
NCDENR
NORTH Cww - DEPARTMENT of
ENVIRONMENT ANo NATIXtAL RESOURCES
Form: Certified Riparian Statement as developed by NCDCM 8/6/09

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized agent:
;uthaorized
r C partme t Transportation, 113 Airport2Drive Suite 1 Edenton, NC 27932 Phone no. [phone]
V
A en '/6
s Signature Datk
Name of Individual Applying For Permit: Steve Trowell agent for NCDOT
Address of Property: SR 1216 Mooreshore Road adjacent Kitty Hawk Bay
(Lot or Street #, Street or Road)
Town of Kitty Hawk, Dare Cou
(City and County)
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, should be provided with this letter.
I have no objections to this proposal.
I object to the project as proposed.
If you have objections to what is being proposed, please send written objections to Ronald Renaldi, District
Manager, Division of Coastal Management, 401 S. Griffin Street, Suite 300, Elizabeth City, NC 27909 within 10
days of receipt of this notice. 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, jetties, breakwater, boat house or boat 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.)
N/A I do wish to waive the 15' setback requirement.
N/A I do not wish to waive the 15' setback requireme Sign Here
(A Q i 4 •
Sign am Date A. —
Amy D. Wells NCDENR
NoRr C ROU— DEPART. o
Print Name EwiRO mM ,no N.VI,I REsouRcE
Telephone Number with Area Code
Form: Certified Riparian Statement as developed by NCDCM 8/6/09

CERTIFIED IREQ ESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following Individual or company designated by the applicant as an
authorized agent:
Mr. Steve Trowels, NC Department of Transportation, 113 Airport Drive Suite 100, Edenton, NC 27932 Phone no. [phone]
Hutnonzea Agent's Signature Date
Name of Individual Applying For Permit: Steve Trowell agent for NCDOT
Address of Property: SR 1216 Mooreshore Road adjacent Kitty Hawk Bay
(Lot or Street #, Street or Road)
Town of Kitty Hawk, Dare County
(City and County)
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, should be provided with this letter.
I have no objections to this proposal.
I object to the project as proposed.
If you have objections to what is being proposed, please send written objections to Ronald Renaldi, District
Manager, Division of Coastal Management, 401 S. Griffin Street, Suite 300, Elizabeth City, NC 27909 within 10
days of receipt of this notice. 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, jetties, breakwater, boat house or boat 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.)
N/A I do wish to waive the 15' setback requirement.
N/A I do not wish to waive the 15' setback requireme Sign Here
Sign Date
to --
Roebuck Properties li, LLC 'RIftomwe" In
Print Name E"""°'°""` AND
Telephone Number with Area Code