86104A_Kitchen, Emerson & Vivian_20210927

loc—awkk\ LAMA 0 DREDGE FILL NO. 86104 Q 8 C D
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I GENERAL PERMIT ate previow permit iwAW'
'1NNew OModification ElCornpleteReissue F1 Partial Reissue
authorized by the Sam of North Carofina. Deparonem Of Emkownef[W Quaky WW the Coastal ResouIan Corr n*don in an area of envkownental con=. purumt tw
A NCAC — 7)4 - I ;LQK) Q Rules attached. bg Gwwal Pem#it Rotes available at the f.8 6*
0.wt Nam -E-Yh C-'V-' F t Authorized Agem
wress 42 ji En Q Prolect Locaom (Coulty)
ty State - No, 71P 'RU347 Street Addres0tate Ptoadflot *(s)
511 Dni
sub&VWM
lected F-]VrS A4 VAr Body enanlunk)
_C(* QCIEA -]UW [:]SRUA E]PWS Clsest M* Wtr. Bd,
W yes/no PNA-- yes/no
Pe Of PmjftV Ac&dky CUY\--'bM-j= Q xv It' -t(o' 4%,-e,,- L-�MN X 10!
m,elim Length .4-/- q t
cess Length
tr (dock) length U Y(C
;ed Piatlorr*ii
)afing Platform(s)
iger pieAs)
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tal Platform area
4�
oin lengthj#
11khead/ Riprap Length
g distance offshore
+
eakwater/Si
ax distance/ length
sin, channel
bic yards
-4
et ramp
athmm/ Bo;3tkft
ach Bulldozing
her
(Scale: I"-=e)
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V observed: yes
XVtDrium: es W J-4—C'
e Photos: no
32rtan Waiver Attached: yes I
wilding permit/zoning permit may be required by: ?Osq U6 k cc,'x V3,4
rmit Condkions;
Q TAwPAm/Nwmwr-FEP, (circle one)
FlSee note on back regarding River Basin rules
f7see additional rAytes/condidons on back
M AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND P"WWED COMPLIANCE STATEMENT. (Please Initial)
wt or Applicant PRINTED Nwne Permit odc RINTED Nan-ve
Yk -9+
IaWre ease read cumpIiancL-_-4Aierr4vt on (rack of permit* Signature
Q00. P_C, q 175b 12-7 I -It

DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED MAY 19 2021
Name of Property Owner: L JP 4 1414cZ e L ZZ kft," DCM-EC
Address of Property:
Agent's Name #:
Agent's phone #:
or Street #, Street or Road, City &
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as show -,on the attached drawin the deveEo-meat
they are proposing.
V 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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, 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 sign the appropriate blank below.)
(Property Owner Information)
CZ4&,1
Signature
f ,Q e;16Aef1
Print or Type Name
Ili J&6 Len,/ a���ire ,cam
Mailing Address -'
Va, 13LO
i y/State/Zip
'7.s7- Gso _.
Telephone Number/Email Address
Date
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Y�r ,
Signature
�s�°,� �' r��-� sue✓
Print or Type Name
9ZZ '
Mailing Address
City/State ip
Telephone Number/Email Address
4;n,,Z Z �, 33
Date *
*Valid for one calendar year after signature*
Revised 2017

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWANER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTE.Q or HAND 12ELIVF-RY
(Top portion to be completed by owner or their agent)
Name of Prop" Owner,. v I Ct �Clk P il K kAew
-0,-L, �acjL 0- Address of Propert)r (\"C
Mailing Address of Owner
Owner's email: Owner's Phonet
Agent's Name
Agent's Ernall
Agent Phone#,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Own
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
desfttgnp, , fiio rdrawinajMLbd1mon
I DO NOT have objections to this proposal. 100 have objections to this proposal.
If you have objections to what is being proposed. you must notify the N.C. Division of Coastal
Managemenf(DCAf) in writing within 10 days offecelptof this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, KCt 27909, VCM 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 osod 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). (it you wish to waive the setback, you must Mon
the appropriate blank below.)
100 wish to waive somelall of the i 5° setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the I5 setback requirement (initial the blank),_
Signature of Adjacent Riparian Prop" Oiwner:
Typed/Printed name of ARPO: V"Lmd XZ
Mailing Ac1dre ss of ARPO:
ARPV* *mail: /L/X— ARPO's Phone# -
Data; . "waiver is valid for up to one year from ARPO's Signature'
Rovrsed jufy 2021

RECEIVED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM MAY 19 2021
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: l�� Ui 4 U rj Jr-- /Jc.41 OLZ, it i >{G lei, -T2
Address of Property:
Agent's Name #:
Agent's phone #:
or Street #, Street or Road, City" & County)
Mailing Address:
DCM-EC
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.
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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, lift, or groin
must be set back a mini um distance of 15' from my area of riparian access unless waived by
me.,(-t�you wish to waivTthe setback, you must sign 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)
Signature
Z- 'd �/, i TC—
Print or Type Name
If
Mailing Address
LDU/L a, a (Or, 13, n 7
City/State/Zip
-25-7 j�o_ 8Sa3
Telephone Number/Email Address
�)- y .) I
Date
*Valid for one calendar year after signature*
Property Owner/Information)
Print or Type Name
;MailijnAddress
City/State/Zip
, �2 -Yyy- �Zld a
Telephone Number/Email Address
Date*
- /9- z
Revised 2017
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