79416A_Jessen, Martin_20210918

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Martin Jessen
Address of Property:
150 Gov Eden House Rd, Merry Hill, NC 27957
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Stewart M Davenport
Agent's phone #: [phone]
Mailing Address: PO Box 100
Creswell, NC 27928
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 drawin with dimensions must be ovided with'this' e{ter.
(Description is a 25 tootlong le ie groin + - 30 teetrom the South end ot the u ea .
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. Contact information for DCM offices is
available at htta://www. nccoastalmanagement. netlweb/cm/staff-listing or by calling 1-888-4RCOAST.
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, or 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Martin Jessen
Print or Type Name
98 Union Ave.
Mailing Address
Edison, NJ 08820-3506
City/State/Zip
732-522-1811 victorianofficerentals.com
Telephone Number/Email Address
07/12/2021
Date
RECEIVE®
1 1 2021
(Riparian Property Owner Information)
CM -EC
Signature
James Hopf
Print or Type Name
2131 Portertown Rd
Mailing Address
Greenville, NC 27858
City/State/Zip
Telephone Number/Email Address
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Martin Jessen
Address of Property:
150 Gov Eden House Rd, Merry Hill, NC 27957
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Stewart M Davenport
Agent's phone #: [phone]
Mailing Address: PO Box 100
Creswell, NC 27928
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 drawin with dimensions must be rovided with this letter.
(Description is a 25 tootlong je ie groin + - :30 teet from the south end of the u ea .
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. Contact information for DCM offices is
available at httn://www. nccoas taimanagement. net/web/cm/staK-listing or by calling 1-8884RCOAST.
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, or 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.)
RECEIVED
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
AUG 1 1 2021
(Property Owner Information) (Riparian Property Owner InformatFahPM—EC
Signature
Martin Jessen
Print or Type Name
98 Union Ave.
Mailing Address
Edison, NJ 08820-3506
City/State/Zip
732-522-1811 victorianofficerentals.com
Telephone Number/Email Address
07/12/2021
Date
Signature
Phillip Van Dongen
Print or Type Name
148 Gov Eden House Rd.
Mailing Address
Merry Hill, NC 27957
City/State/Zip
252-482-1616 / [e-mail]
Telephone Number/Email Address
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Martin Jessen Q Fl .E IVED
Address of Property: 150 Gov Eden House Rd, Merry Hill, NC 27957
(Lot or Street #, Street or Road, City & County) Z�
2l)
Agent's Name #: Stewart M Davenport
Agent's phone #: [phone]
Mailing Address: PO Box 100 _��
Creswell, NC 27928
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.
(Description is a 2TFoot long le ie groin + - 30 feetfrom the South end ot the u ea bdo� 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. Contact information for DCM offices is
availableathttp://www.nccoastalmanapement.netlweblcmistaff-listing orby calling 1-888-4RCOAST.
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, or 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Martin Jessen
Print or Type Name
98 Union Ave.
Mailing Address
Edison, NJ 08820-3506
City/State/Zip
732-522-1811 victorianofficerentals.com
Telephone Number/Email Address
07/12/2021
Date
(Riparian Property Owner Information)
Signature ' O
Phillip Van Donoen
Print or Type Name
148 Gov Eden House Rd.
Mailing Address
Merry Hill, NC 27957
City/State/Zip
252-482-1616 / [e-mail]
Telephone Number/Email Address
Date
(Revised Aug. 2014)
I\1eV(y1*,rtCei0 dt,6crl 1-+1on 07

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Martin Jessen
150 Gov Eden House Rd
Merry Hill, NC 27928
Installation of a
New Jetty
Stewart M
Davenport
252-394-6015
smdincl Cmsn.com

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