84920_William Antrey_20211004

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- , 414tet.111cAmAd, o.:Ill DREDGE & FILL oim No 84920 A iii_,)C D '
a 4 Vi 33v Previous permit rt./id
..,. GENERAL PERMIT ID• • ' -
._. Date previous permit issued ,,,, ./4
, •
2 New ['Modification El Complete Reissue 111 Partial Reissue
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:
ISA NCAC ( 71/ /2 OO /9 71/',-:?Y f'-,6-; 0 Rules attached lirdeneral Permit Rules available at the following link:wwwdeq nc gov/CAMArules
.,)•
Applicant Name tpi it.',..-i- /1,1 r.,,, ,..- Authorized Agent A//-'1
Address ,,:,.?I 71,.;.2, . 1 ., .,„c,,- se,11"
. , Project Location(County): /re:44i.e, / ,i ..-
. City 4--,,L1,..„4-0., iff,v,,,, State zWe-44 0 ZIP 40.;,7 ifi I/0 Stieet Address/State Road/Lot#(s) /....r) 1 7(2 , ''..;,.-, e e / ../4? A
Phone#(V!L 0) 'L7.1 .,..51.?
. c--
Email
Subdivision ,.._..)h,,eA c,‹/,,,--, er;ve. •
City rie,A 4-vt•-1.. ZIP
/ .,..- .
Affected El.& DEW DPTA 2 ES ' OPTS Adj.Wtr.Body 4/,- t ./e,-.- / (n*rhan/unk)
1,,,i2 /
AEC(s): 20E4 2 iHA 2 um' 2 SPIMA III PW S Closest Maj.Wtr.Body / 'A , l' e.- ./1;: -
, ORW:yes/no PNA:yes/no -, '
,
Type of Project/Activity 4 -I/ ,;re -,-.), e:r eel f X/2 i - L..., . /4 lo I 4i J..)//1.::.."A-1
, I
(Scale:/
,
Shoreline Length / (")C.) ---'4-' C4-itt
Access Length c-2 S.'. ‘ IIIIIIIIIIIIIIIIII 111111111110111011111111111111111111111011111111111111111111111 „
,---- . IIIIIIIINIIIIIIIIIIIIIIMINIIIIIII.MINNIIIIIIMINIMMIIIIIII11111111411111101
Pier(dock)length - IV/ P415, ''',.48"' Mill 11111111111111111111111111111M111111111 111111111 a11111111111
Fixed Platform(s) /IL?, x 4-, c
ss "'-) t 111911111111=2111111111111111111 1111111.111 11111111111
•C --' i I'. iiiilinia li anummoNtamowliamidiroM .1111111-
,.. Floating Platform(s) / IM1111111111111111111111111111111111111111iIIIIIIIIIIIIIIIIIIIISCULIMINIIIIIIIIIII
( IMINIIIIIIIIIIIIII 1111111111111 III 11111111111111111111111MININIIIIIIIIIIIIII .
Finger pier(s) \ ' • 111111.1111 111111111111 III rmun
is a
Total Platform area -.....7,437,2-1/ '2 IMINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIM1111111111111111111111111111111111111111
Groin length/# --- 1111111111 11111111111111111111111MISE 1111111111111111111111111111111111111111111111111111111111
Bulkhe"adtiPiDength ./'''.'4, ,,„,,,,..r pqramigagagotoramag
Avg distance offshore C.,' 1,-, Z., imaripsiminumill= LIVIA111===11.161.111111111111
MEM 011111111111111111111 III ININIIIIUIIIUIIIIIIIIIIIIIIMIIIII
' ..
Breakwater/
Si" t'' ' airmanirommormanammarimusumasimammiumis ma
Max distance/length ' - INIMININIIMINIMININIBINIIIIIIIIIIIIINUNITINIMINI1111101111111as
Basin,channel Knimanimmeini iiinnsii iiiumnii imianisiiiiimiiiiiiion
Cubic yards, . . i .iiiilliiiIIIIIIIIIMININI INNINIIIII 1111111111111111 111111111111111111111111111111M
' Boatrar1113 ,--- /,. ,- INIIIIIIIIIIIIIIIIIIIIIMIMINININUNIMMI1111101111111111111110111111111111111111111111
Boathouse 1C/;-./ Li:2' amingwmpassimanimmeashommtgammiamigommuminagisi
Beach Bulldozing ,-/ L ' tftwocamagl --:,__ MN njummin as wow
Other: C MN r a .-'.- no
a - - HI Plow IN
- -- , _ INIIIIIIII,11111101111111111111111 MEE'. IIME=MENLVINamillIINIIIIIIMIIIIIM
, , glianammanas ' NININLIIIII IIIIIIIIMMINIIIIIMINIIIIIINNIIIIIIIIIMII
.SAV observed: yyeess (rid) as - a11.111Millialilli 1111111111111111MINIIMM ,-'
Moratorium:. n/a n0,, al im is rillni esurgerm,Site Photos. -(1") 0 INEANNIILEL IN II M Riparian Waiver Attached: "yes ns,
4
-A building permit/zoning permit may be required by: /ref.,,-..t.,I/::.'''' (...."; 1—1'..''—".--
I 1 TAFt/PAM/NEUSE/BUFFER(circle one)
Permit Conditions rte;e.4 r,t''' '1;c,- i',', C/ I,e 7' .., ,, — (_...,- /1,, i
..----
' -as'i 61 r, 4 V V V V V V ., V V .2 See note on Imck regarding River Basin rules
. . :
ElSee additional notes/conditions on back
, .
,-
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) kk) . . \ :
Agent 9.110,I i c a‘n f'R I N f Ep Name' 4 VVV Permit Officer's-PRINTED Name ''', •
I PI I 17A 4,4 A
Sigilata readcomp e**Please lince statement on bacts20ermit" ' . -Sig-nature --
4(1606) .ofe •
S'', / , • ,
Application Fee(s) ' - , Check#/Money Order ' Issuing Dale rxpiraiion Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax:[phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River,Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick,New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

F��;� `r... . No 84920 f A B . c D
• �,o� n CAMA n'bRE®GE & FILL ;
i _ GENERAL PERMIT t °1 - Previous permit .,.-_i° -'
Date previous permit issued• .r- /—
) -'' n"New 0 Modification n Complete Reissue n Partial Reissue
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 i - ' 1/ /;'t�c-' n Rules attached. n.General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name ., ,_ Authorized Agent
Address . - •-----,( , ,--_ • i 5 Project Location(County): / .` - '
..
City 7'7..--»t<;=r<_- ,—.7. .r" State .•i';'. f• . f-f ZIP ,'' I ' Street Address/State Road/Lot#(s) / 't- a / .
Phone#(1=6) 'C . ,`l,
Email Subdivision '- - '
City / • // . - . ZIP ,'42
Affected 'L.-"CW n EW n PTA n ES n PTS Adj.Wtr.Body / -- •` (nat/man/unk)
AEC(s): n OEA n IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body `` ,-,, , ,,.. .
ORW:yes/no . PNA:yes/no
Type of Project/Activity _ , . 'r...- . . �'C '! f F -•
_ (Scale:1 ' )
Shoreline Length ./' .? ' 'i`'
Access Length _' 11
Pier(dock)length A'' - . .....
: ,_ , = i I .
i ,
Fixed Platform(s) /t. > II' ..... ..., ....... .:. j - , 1111
Floating Platform(s) 1111111I
d M1111.
Finger pier(s) '` —� - .. i ...._.. 111.11111
IR: rii
Total Platform area ,' 71 : -
Groin length/# --- Mall .I .
Bulkhead/,,Riprap length /- '-''i j---- — - - -
Avg distance offshore
all
Breakwater/Sill I
Max distance/length ij 4: I l
Basin,channel i I
• Cubic yards + j Iminas •
/
Boat ramp
Boathouse/Boatlift I
' Beach Bulldozing -.mrIMIIIIIIIIIMIIIMMII
`� lOther ;. mu slow
MI
1"'`4..._.. . • ,
—�__
1 , s 1 i
SAV observed: yes no f a l l
Moratorium: n/a yes no, —" EMI 111 i
Site Photos: .yes no -- --
Riparian Waiver Attached: yes :no _.—i
A building.permit/zoning permit may be required by: / • -• • • .
Permit Conditions {' TAR/PAM%NEUSE/BUFFER(circle one)
, t n See note on back regarding River Basin rules
nSee additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) \i'\) . VA
Agent or Applicant PRINTED Name ...,„ . Permit Officer's PRINTED Name ''
Signature**Please read compliance statement on back ofpermit** Signature - ,
J ,` /:- .+ '/ a', "' ./11/ r'..; a
Application Fee(s) Check#/Money Order Issuing Date Ezpiratio( Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax:[phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax:[phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington,NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck,Dare,Gates, Hertford, (Serves: Brunswick,New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

•
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 026.0233 &.0259. The
Division of Coastal Management (DCM),through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
.with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act(CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party (contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to $25,000 per day per violation.
i. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees) unless.otherwise approved by DCM. The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width:The width of the pier or docking facility access way shall be limited to six (6)feet.
4. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing Will be used to aid in compliance and monitoring efforts.
0 Pre-project site conditions: GAXA dt LtGe( 1...14,1r -/atij- 74vyw,4J
s- /✓G I is t
By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify
that all information provided is complete and accurate.
•
Agentr Applicant Printed Name ermit Office s Signat re
t� LAA-6" . /O/i/2,
Agent or Applicant Signature Issue Date
CAMA GENERAL PERMIT#: gT 902€9 13
State of North Carolina I Environmental Quality[Coastal Management
• Washington Office 1943 Washington Square Mall Washington,NC 27889 1252-946-6481
• Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-3845I 910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 1252-808-2808

ROY COOPER
;? ' Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE FOR SHORELINE STABILIZATION
A riparian buffer authorization is required for shoreline stabilization activities within the Neuse and Tar-Pamlico River
basins per Division of Water Resources(DWR) regulations 15A NCAC 02B.0233 and 0259. The Division of Coastal
Management(DCM)through a Memorandum of Understanding with the Division of Water Resources(DWR) has
reviewed your project proposal and has determined that the project as proposed cornpl.ies'with the aforementioned
regulations.
•
Those activities covered by your Coastal Area Management Act(CAMA)permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party(contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to$25,000 per day per violation.
>. Impacts: Impacts to woody vegetation from clearing and filling in tone 1 (begins at the most landward of either.
normal water line(NWL) or normal high water line(NHWL)and extends 30 feet landward)shall be minimized to
what must be impacted for the sound installation of the shoreline stabilization project. Unnecessary clearing and
filling in the buffer is a violation of the riparian buffer rules.
2. Clearing&Grading:Clearing and grading of Zone 2(begins at the landward edge of Zone 1 and extends 20 feet
landward) is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes
maintaining diffused (non-channelized)flow of storm water runoff through the buffer.
3. Construction Corridors:Construction corridors are allowed for shoreline stabilization projects, but they must be
satisfactorily restored as described in condition 5 below.
4. Potential Overwash: For vertical shoreline stabilization projects (bulkheads)only;sites where wave overwash is
expected to be severe,the first ten (10)feet landward (unless specifically authorized otherwise by DCM)from the
structure may be maintained as a stable lawn in order to provide for structural stability. •
s. Temporary Stabilization: Immediately post-construction, bare soils must be stabilized as quickly as possible by
providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting.
This ground cover is a temporary measure used to address erosion until site restoration can be accomplished.
s. Site Restoration:At minimum,pre-project site conditions must be re-established.A site that was wooded prior to
this shoreline stabilization project must be restored with woody vegetation at a stem density of 260 stems per acre.
Non wooded sites may be re-vegetated with woody vegetation. Restoration must be completed by the first
subsequent planting season (November 1 through March 30) after completion of the bulk ead. /
© Pre-project site conditions: CA . .1—/ — 90% LA- J t oY^e4-4,
7. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property
indicating the location of the shoreline stabilization structure and any associated clearing, grading,and construction
corridors.Thls drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the above listed conditions and verify that all
inf rm t;on is co pled accurate.
t I AAA.
Ag tt o pplicant P ante arse Permit Of ices Signattr
/0 /A.
Agent or Applicant Signature Issue Date
CAOiIIA GENERAL PERMIT#: erY9,-2a
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington.NC 278891252-946-6481
Wilmington Office 1177 Cardinal nrive Ext.Wilmington.NC 26405-3.845 191C-796-7L15
Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 1252-808-2808

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CERTIFIED MAIL 7 RETURN RECEIPT REQUESTED
. .
• DIVISION OF COASTAL MANAGEMENT
, .
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
/
Name of Property OwnerV
: 11171 .1.1:171EY Ver et CI4
3, 1 d-
ea
Jo -.
- Address of Property:. c:077. 6-r P.-a Dir---1/1 4Ver 1././L ze o
- (Lot or Street ik Street or Road,'City Si County)
Agent's Name*. • Mailing Address:
Agent's.phone#:
I hereby opitly that 1 own :property adjacent to the above referenced property. The individual
applying forthis permit has described tome as-,shavm on the attached dthwing.the development
they are:proposing...A description or drawino with dimenSion :rriuSt be orovided With this-letter.
I have.no-Objections to thiS proposal. I have,ohjectiOris.to.this proriosal.
ifyouhav!pbjectio-ns to what is being propose4 yopmeistrtotify the DiVi*lafi of Coastal 11,7artagernp_rit
writing witftin"0-citros Of receipt of this-notice 'Coripct fhforinahron for 0CM offices Is
available ryflL cvr 2orbycaI1#ng-1;88-8.413COAST,
No response is considered ihe_sameras no objection:if you have been notified by Certified Ma!!
•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift,must
be set loack'a minimum distance of 15's from my area of rirrarian.access-.UnleSs_waived:bY me. (If
you wish toWaive the:Setback youimust initial the appropriate'break berow.)
do wish to waive the 1.6 setback requiremePt,
I do not wish to waivethe 15'setback requirement
, .
• .(Property.Owner information) (Riparian Pro rty Owher?rmatiOn)
• ' 72:4cf,e-e- -.1-,• 1 &C.
Signa!T4rre.Signafure
•
. V41 1 U , kczPA 0 0
Prirdar Ty/Pe-Mine Pint or 7:1;fiP.4 faleine
Mailing
,RWA .,„, -4 a 3 Pat'ROD_ci •
AddreSs Mailing Address
„ „ RAPVA .Mr /I4O N.C .
.
CnyState.Orj, CilyiStateiZO
/ •
dczu.c yr e±.
Tekphorre Arymbsr....tEmariAriorteSsi Totoplacine,Number/Erroll Address
. - I/a 7
(Revised Aug_2a14) .

F
a
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
.ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:MO IG�hrl -EY ��ef'o, (-tt r, i .
Address of Property- �.k3d St 1 S6-f- &
rty:p I� !<di• B sci`?u ue./N6' 27,90
(Lot or Street#,-Street or Road,City&County)
• Agent's Name#: Mailing Address:
Agent's phone#:
I hereby certify that f 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.deseription ordrawinq;-with`:dimensions;must befprovided.witht.this letter.
74.4A4il have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notifythe Division of Coastal Management
(DM in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http:/Jw w.hccoastalmanaoement nettweb/cim'staf Mistino 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 •
(Pro erty Owner Information) (Riparia rop Owner Information)
A )4 ,n
. ,-;-2,4,„
ice,...,_ 4._ v, „:-......„
4M'
ignature Signature
//L -s T �• 7/'i c n
WI 1h& -IVY 1------y1 7/L44,Y ) /n/N L
Print or Type Name Print or Type Name
3( 7 `iRkvA- get, LfZd7 24,L,=2-r tv _.pi/i t 9�
Mailing Address Mailing Address
2.1 4 1 Mb Z 1140 elm (3 ,11 --/I 04.N; 4.--3 4
City/State/Zip q r City/State/Zip n
410 4&6 9s73 F'VInfiC �`�'✓VW, w' f/S4( r '� S 7/ , /
Telephone Numb /Email Address Telephone Number/Email Address
itzZl Z ( 1 --23 - 202.
Date Date
(Revised Aug. 2014)

•
•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to lir//L4..i,4.4--t 7-.0)*y 's
(Name of Property Owner)
property located at L,a r 3 o .5 oiv s ,- ,poi^.;-AL S,m vc6 t , C'oil,.
(Address, Lot, Block, Load, etc.)
on ( c�5� CQ��1� , in 6 4_L 1/4egA) , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
0-1H1 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
lridivrdual:'_ro o„_,p:r`p_ srng afevelopment;mustklfin;•_descriptionaje>rowTor,atilaChasite_drawiiig)
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 initial the appropriate blank below.)
�//������ I do wish to waive the 15' setback requirement.
72 I�FM� I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent P perty-Owner Information)
Signature Signature*
Ka.1 Wag-
Print or Type Name Print or Type Name 6.CJ/LL14,n, ice, j/ivy g,
Mailing Address Mailing Address
''ZR t=/lGr eTarw
City/State/Zip City/State ip /
Telephone Number/email address Telephone Number/email address
/ - 2 3 -262
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*