84958_Les Pendleton_20211014

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ROY COOPER
Governor
MICHAEL S. REGAN
A 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.
e Pre-project site conditions: L. / ;3
By your signature below you agree to be held responsible for meeting all of the conditio listed abo an erify
that all information provided is complete and accurate.
Agent or Apn inted Name it Officer's Sig ure
4hdo /j /v/' 7 2
Agent or Applicant Signature Issue Date
CAMA GENERAL PERMIT#:
State of North Carolina I Environmental Quality[Coastal Management
Washington Office 1943 Washington Square Mall Washington,NC 27889 1252-946-6481
• Wilmington Office 1 127 Cardinal Drive Ext Wilmington,NC 28405-38451 910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead Citty,NC 28557 1252-808-2808

,a°`mT" I c CAMA III DREDGE & FILL Na 84958 A VC D
1 1 GENERAL PERMIT Previous permit
Date previous permit issued �4-
I�'New III Modification El Reissue ❑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:
I5A NCAC 7/'7• /2-oG7 ❑Rules attached. "53 General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name /'t° 7- WG� 37 - Authorized Agent (/
Q� �..r
�� / �7%
Address
^� / � � .� Project Location(County): ������-Y
City /✓,t��/Y State' �� ZIP 2 g560 Street Address/State Road/Lot#(s) QZ-/,U r l/ e A'
Phone#(2) 632 97 Tc�
Email Subdivision %/-4-0-- /J /
%76 "
City itiw- /t- ZIP 9
$Jy F;5
Affected ❑CW ❑EW TA ❑ES ❑PTS Adj.Wtr.Body 6 4,, 'V741"- Li��I- 6O K at/ ia%unk)
AEC(s): ❑OEA ❑IHA I I UW III SPIMA El PWS Closest Maj.Wtr.Body - iiJ
A/ .w-L'51 e cg4
ORW:yes& /PNA_:yes,
Type of Project/Activity /
//C %"'/o'E)z P 5 4 /C/iJ/Z 72—u2s C_
,Al i',.S % , 1,,,-I. (Scale:4Z )
Shoreline Length 4- /_ c'
1.111111111111111A
Access Length � _ CIfR !4 ' , limi
/v�'�' ,•` _ _ f_
Pier(dock)length I al 1 al
Fixed Platform(s)
1 . .4, —I
I I
Floating Platform(s) 111111111111111 1 —r—.----Prier,-, , 5- /_
i
ffk*IEI! IIIi 111111111
Finger pier(s) I-, --- -f �� I-�/„ ��e �' -
I I N �� 1 '
o
Total Platform area i _. I
Groin length/# I 1 I
Bulkhead/Riprap length ----- -- — —�--TT -+---— r c -_•'-t4.5A. 1
Avg distance offshore c)
Breakwater/Sill - __.r_ � , I E �
iffia
Max distance/length I
, ..„..,_,....
i i� 4- I or }
Basin,channel ( ;III - -�" '-
Cubic yards ' I 1.
Boat ramp - j . I i ■
Boathouse/Boatlift i j i I
Beach Bulldozing )� I
i ,
Other
Cv�-) poi 1:l9 5 .lD I e/` I I iME—mil -1 a .
SAV observed: yes 4._._,.._r ,_.i_ __ MEI _. ____I..._._....----NM:----i .A1
Moratorium: n/a yes weV' rim
1.
Site Photos: y, -j-- -- ! II
iWiverAttached: si _ _ -;-_ _ #
A building permit/zoning permhit may be required by: ' /?6 f a ,,_41-4,/ <'/0_ �'�
Permit Conditions `}�fjt!, 'c 1 r1 j i�t � �,u�� S TAR/PAM/ /BUFFER(circle one)
CO i,U� ' (tic 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 STA MEN , (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's NTR m
Signature**Please read compliance statement on back of permit** 'gnat re
6 .. p91, -.2 e`� 1-‘,- --Zs /`D- /1-/- ,.2024 - 2/Lie °L�
Application Fee(s) Check#/Money Order Issuing Date Expiration 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

°``°Aude i.CAMA'. n DREDGE & FILL , ' • N9 84958 / - A ,mac D
). GENERAL PERMIT Previous permit j
Date previous permit issued 4/ -
i .
[(New n Modification n'Complete Rei°ssue`'irl,Pirtial 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 ` /ii /2 0 ..�Rules attached. '® General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name ? , l /.t--I,�.~i_/'� "7"‘ Authorized Agent """" ' ./2;4-ff". ,.,+7
Address/ v7�,. A.a-f/ C. 4 `Project Location(County): � , /--.-,
' City /1/-v r....".i, �r '1
''' - -•State l'/C ZIP 2 g5-6 e Street Address/State Road/Lot#(s) (11' Q"/ /-40 e/7 e 4,
Phone#(9/.9) /,,1 `.71 frg // / f
Email Subdivision 4/i„, I-ic,,--,t,'f //'1- /•-%2"'' rq " -^
City .�tzs / ,,--1 ZIP . 2- ,7 d.,
Affected rim n EW 0-TA n ES n PTS Adj.Wtr.Body F'�- (7 `/�' el'GY °c1f``��` �`eAk at/pman/unk)
AEC s:. OEA IHA. UW SPIMA PWS /1 ., :.a/-i-Si- eo"-L'+�-,`L
O n n n n n Closest Maj.Wtr.Body l 1i� .aid /
ORW:yes/no PNA:yes no ,
Type of Project/Activity A. ✓�/"n�-••._ Re>4l',50 S /Ci ',G'/'.,C - _7e7.-z.s-z>^ - 6 i
r?i/.% ;51.5' 'i' f ��4 r e-c-.e-?- (Scale:4 Zr, )
Shoreline Length" -I- r 5-c.' •
Access Length, ,, / I I ! J, .r . A:it,,,'.(.f e•./-. -
Pier(dock)length i I . '
Fixed Platform(s) I I
{t i � '� - --
Floating Platform(s); 1 Z/?
-� / [ � A ✓
Finger pier(s) • 1 I ! 0 �.1i - /7�t"t k'a'?` tom:. ,
t
Total Platform area - # j
Groin length/,#, } •
Bulkhead/Riprap length _ ---- -- •—I---- — - >, I 7�
Avg distance-offshore i `"�{, &-"`:. '•' ``-a M' ' ) 1 / 1r ',;`(`)/ / ' e
,, Breakwater/Sill - /' I 4 ! ,
Max distance/length a
Basin,channel '
Cubic yards • • f 1 ;,, .•— A)�,.�.,t .
Boat ramp ' ' P , ,,
Boathouse/Boatlift j -j• j I "
- .Beach Bulldozing •n -- ✓ --- ht, 4e � ^ ,,_, ..
Other.( tom/r/i,�l,� �,'- s W f� 1 �1�.� __ -- • ^ s �°.s.
SAV observed: - `,-yes no t i• - - '
Moratorium:' n/a yes ' -
Site Photos: - .
•
Riparian Waiver Attached: dyes- no r / /� f /) �/
A building permit/zoning permit may be required by: / 1/,i`vii / E<%Ji' h< f' ✓r�r r..4.- -'
r X TAR/PAM'/NEB BUFFER(circle one)
Permit Conditions I ,-,0�r s•.. i ,-1 + ,—.c: . ,.4 ( t)'i,n.`' i� L..�n o1 (
--
N% 1 t)e t. 4.7f( - - y' See note on back regarding River Basin rules
I
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
-- 1,1,-cz4 a is'--/ ;
Agent or Applicant PRINTED Name Permit Officer's PRIN QFNameZ ,,
Signature// **please read compliance statement on back.of permiittt***�J 7 `°-'"Signiatuie/) C�,�✓ `� C }
7 / Z) e'l : - . l .F•-./-^•-7r /D- /.`�/- t-Q 2./ ,.�". -f •---2-aZ"' ,'
Application Fee(s) - Check#/Money Order Issuing Date Expiration 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

�o*°`°"r� l` 1 CAMA I-I DREDGE & FILL -• No 84958 ; 1A 'C D
GENERAL PERMIT Pre"`ouspermit1%�
J Date previous permit issued > %'
nNew n 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:
e
I5A NCAC 7/-J• 1 ,2'--1-2e' -.'❑Rules attached. "J General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
__-_7 f;
-,-_. /a
•
Applicant Name ) .._..:- a,r�-' C-r`'r ••r.,./,/-'��';�'� Authorized Agent '"�'-"""'"- ( ;<f 1• Vr.:.'r, .)
Address fj.t.•(/ >r= .,r 3. f rf f Project Location(County): ``'` �"' t yri r? > •
City /1' r._ /.'r-" a State ZIP Street Address/State Road/Lot#(s) : L:' ,/ ,r'if..r/ -
Phone# t✓ .. '
Email `� Subdivision , -;, • , , ,., ' ' //-
' .) r ZIP ---`' -',e-'%
h' -
/
Affected n CW n EW n PTA n ES n PTS Adj.Wtr.Body ) '`�' ' • :/
-(nat/m an/unk) •
AEC s: nOEA nIHA ❑UW III d r f• `r• /7/y ; -"i ' (` //=Closest Maj.Wtr.Boy /,r i!, . . ,
•
ORW:yes/no) PNA:yes/Zno?
Type of Project/Activity / ). ,// E". 1 / -f .,1! - 4- , , .' /"• C /i-'-,f i -rn
', i..• . » // ` /- - - i (Scale:,/ )-,r,
Shoreline Length / / '• '
Access Length r, r , ( ,.
Pier(dock)length
Fixed Platform(s) , 1111111111111111111111111111 111111111111111111111111111111111111 111111 Nip
::::::orm
II
Total Platform area
Groin length/#
Bulkhead/Riprap length
Avg ditante:offsho re
Breakater/Sill -
. Max-distance/length
Basin;channel • 1111 �■ ! ■■ � 11II■ . •.. . 111111111111111011111111111
.■ ■■■■ ■■
Cubic yards f i --
111
Boat ramp • ---
Boathouse/Boatlift `„.- "
Beach Bulldozing :/i'
Other _f — l
SAV observed: yes no . { I
Moratorium: n/a yes no f
- Site Photos: yes ('now p l '
Riparian Waiver Attached: ayes- no 1 1
• A building permit/zoning permit'may be required by: /r r,,/, ,•./;: / / ''' f•' / `-•' �'.�'/--" r_'•., .
_TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions I r r;r r. .-t• -r ! r i J'✓+ 1- - .
f E See note on back regarding River Basin rules ,
f
❑See 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)`-
Agent or Applicant PRINTED Name . Permit Officer's PRINTED'Name/ I.
' J
Signature**Please read compliance statement on back of permit**itl . '~'•Signature 'i '
( f /- / �!!.-, Jf 2•2-- '7. /i')- /''i• ,'/2 / /'`./(i/ . .'60- --''
Application Fee(s) Check#/Money Order Issuing Date Expiration 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

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY'OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner Or their agent)
jj��
Name of Property Owner: hO( )9Rl) L E
Address of Property: ?O9 �.)LC(�E C C COCA AT—
Mailing Address of Owner: C/09„J cog-L L
Owner's email: 6 I ,Caa^ Owner's Phone#: C�/9 97y&
Agent's Name: NA Agent Phone#: MA.
Agent's Email: NA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must.notify the N.C. Division of Coastal
Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be •
contacted at(252)946-6481. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift,or groin
must be setback a minimum distance of 15'from my area of riparian ac -ss unless waived by me(this
does not apply to bulkheads or riprap revetments). (If you wish to-wa' e t.e setback,you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15'setbac \ 1
Signal re o,'adl..'cent"ipa '-n Pro•erty Owner
-OR- ,
I do not wish to waive.the 15'setback requirements(initial the blank)
Signature.of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: el-TT e-43
Mailing Address of ARPO: 9 t 7 � 'Q +-
ARPO's email: J .f 0Y y 2 a 0)` ARPO's Phone#: S.(v D— `f 8 81�78
Date: 10,g 17-1 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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N.C. DIVISION OF COASTAL MANAGEMENT ;.• 1.:r:-,
t N"T RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER � ��
TU AIVER FORIfA �� '.
RECEIPT RE UESTED or HAND IV r,
op Portion to be completed �',, , __,
Y by owner or their agent),.'Ain et sty owner.
of C
Mailing Address of O � w I
vner_
' , - a 840, * Owner's Phone#: gip / '2 9 7' `
it's Name:
Agent Phone#: A 4 ,y,
Agent's Ernatd: A •
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION _ --Bottom' ortion to be com feted b the Adjacent Pro a Owner
f hereby.certify that I own property adjacent to the above referenced property.The individual applying for ti-ts
;:+er-r-;t has described to me, as shown on the attached drawing, the development they are proposing A,
descri 3on or drawl with dimensions must be rovided with this letter.
styI
t DO NOT have objections to this proposal. I DO have objections to this P r
ff
you have obtections to what is being proposed, you must notify the N.C. Division of Coastal
Management(DCM)in writing within 10 days of receipt of this notice. Comes
mailed to 943 Washington Square Mall, Washington, NC 27889. OCM representatives ativescan shoulde bbee
contacted at(252) 946-6481. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
i urvJersnd that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift or groin
nit be set back a minimum distance of 15'from my area of riparian access unless waived by me tthis
does not appiy to butkheads or riprap revetments)_ (If you wish to waive the setback,you mu,stsia the
app-o -:.ate blank below.)
i DO w to waive sorne/all of the 15'setback _
wish
Si tuna of Adjacent Riparian Pr rtv Owner
-OR-
t do not wsstt to waive the 15'setback requirement(initial the blank)
•
Sr moat of Adjacent Riparian Property Owner: I
Y+,
p YRirirrtet#new of ARPO: X j3�,d t. &
w . , i<' C. d t'2 •{1,pr� , �� 4 Tii ty' �91 t
i` 1,-- ZO 5I ey h a* r y` 1 9
,4-; -t ' i}' �Y d�.CV�yj��PQ'S P13QE1�+R. �} ( �`J f I� ��F l
R fi
�` '"" ; ;t_ *waiver is valid for up to one year from ARPO's Signature' k,;q(
� '} +# ' v Revised Mai,7021, :ry"v>v.-r 41 '
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