79323A_Country Club Drive Boat Basin Association_20210706

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to the Country Club DR Boat Basin
Association's property located at 212 Country Club DR, on the Albemarle Sound, in
Edenton, N.C.
Agent's Name #: NIA Mailing Address: N/A
Agent's phone #: N/A
N/A
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Repair/replace 150 feet of existing bulkhead from the Albemarle Sound, North to Country
Club DR
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, iVo response is considered the same as no objection if you have been notified by Certified
Mail.
(Propgcty-Owper Information)
// s /' n
Sign-ato " _ ' - L w V - —
Stephen Guttu, Vice President
Country Club DR Boat Basin Association
Print or Type Name
PO Box 1203, Edenton NC 27932-1203
Mailing Address
jacent Prope r Information)
Sign re*
Elizabeth S Brentjens
Print or Type Name
218 Country Club DR, Edenton NC 27932
Mailing Address
252-339-9997 sguttuCcD-mchsi.com brentiens(a)-mchsi.com
Telephone Nuumber/EEmail Address Telephone Number/Email Address
�V`o-e 7,,:,
/ - r &.,e
Date 1,J Date* E
*Valid for one calendar year after signature* Revised Jan.2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to the Country Club DR Boat Basin
Association's property located at 212 Country Club DR, on the Albemarle Sound, in
Edenton, N.C.
Agent's Name #: NIA Mailing Address: N/A
Agent's phone #: NIA N/A
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Repair/replace 150 feet of existing bulkhead from the Albemarle Sound, North to Country
Club DR
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.
(Props O er 1 nation)
Signs ure
Stephen Guttu, Vice President
Country Club DR Boat Basin Association
Print or Type Name
PO Box 1203, Edenton NC 27932-1203
Mailing Address
252-339-9997 sauttu(&mchsi.com
Telep one Number/Emai Address
Date U
*Valid for one calendar year after signature*
(Adjacent P perty Owner Information)
Sig at r e*
Ryan Cook
Print or Type Name
208 Country Club DR, Edenton NC 27932
Mailing Address
-721-c52--10?5
Telephone Number/Email Address
Lr( 2.i/Z1
Date*
Revised Jan. 2017

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