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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER
CFRTIFIFD MAIL - RETURN RECEIPT REQUESTED or HAND DELIVI
Name of Property Owner: UL- 0
Address of Property: 1 c51 ;ZW L'R ►v Z -yTG N L a 1Ck
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
EIVED
APR 302021
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 have no objections to this proposal. e 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
JIQQ-
Signature `
1?A►,L C' 3 E te, tJ
Print or Type Name
4 3�3 i_O
Mailing Address
.\jA 2 33 -71
City/State/Zip
?(kg- W ZIPTEnIO�)
Telephone Number/Email Address
Date
(Adj cent Property Owner Information)
Signature
Print or Type Name
Mailing Address
ity/State/Zip
Telephone Number/Email Address
_,-3act:� /
Date *
-EC
`Valid for one calendar year after signature*
Revised 2017
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
RECEIVED
Name of Property Owner: i?PUL U- i2,R tG ►J
APR 302021
Address of Property: kb] gmeL D9k\)E 4 W�,JTetj tJG
(Lot or Street #, Street or Road, City & County)
DCM-EC
Agent's Name #:
Agent's phone #:
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 shown on the attached drawing -the development
they are proposing. A description or drawing with dimensions, must be provided with this letter.
&_ 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)
. TQQ�A
Signature
YPUl_ c ?,1� ►J
Print or Type Name
y3a3 MtCiAAe-Lil, L,,)
Mailing Address
qg a 3 3 ,1
City/State/Zip
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Stgnature
14,etA' ,� . Sct/J'o ,Li ci
Print or Type Name
/4 tlyat. bp -
Mailing Address
City/StatelZip �—
-)51-yiQ,-41iL1 I 3&kra @ GNA,L.e, h 15'7y12�a2t, /askev'cI&cscr-c
Telephone Number/Email Address Telephone Number/Email Address
3101aom
Date
1 .1 2/
Dat
*Valid for one calendar year after signature* Revised 2017
RECEIVED
APR 302021
DCM-EC
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