84940_John Lyon & Steven Persche_20220203

' > S No 84940 A C D
4c°"` nCAMA I I DREDGE & FILL (n 9 01 9
GENERAL PERMIT Previous permit
Date previous permit issued /J A
F1 New I I Modification n Complete 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:
ISA NCAC 0 4 H H. c-)Gz-m- 0 Rules attached. n General Permit Rules available at the following link:www.deq.nc-gov/CAMArules
Applicant Name �J n���r� )!�� .r �• Sl�° ,,..1Q h t t' -i. 1 Authorized Agent c,---•,_ ?:j q-s
T..• ,t ..-i.
Address • 'c-r P'7K)C k-‘D ex.:: � V S. i t Project Location(County): T' -: .+� L-.(, .t
City - ; •' State '•-.1 C. ZIP `►-, :'A Street Address/State Road/Lot#(s)
Phone#( t j 9) 1 c is - r C-}-(.o .1 &-•,k �.< f cl r �, c..a
Email , , rC41 r+- ;-(./,,1 Y rv.Cr Cj`��._ , 1. i_ ,,\AY-. Subdivision ' • -- Z,t-`4 `",K 1).:i
J City ZIP SSC,
Affected 0 CW n EW ®PTA n ES n PTS Adj.Wtr.Body OA/man/unk)
AEC(s): OEA I-I IHA ❑UW n SPIMA n PWS Closest Maj.Wtr.Body .- J L it ,,
ORW:yes/rib PN9r` /rj4i +�b„,‘let ek
Type of Project/Activity _ - - f/
(Scale:. .r
Shoreline Length -',4----
Access Length / - f 1-t' • i , .1 I rQ • I I i {
Pier(dock)length • kik 1 I
h`
} .
( •-fr •E' . t
1Y Fixed Platform(s) •- , �-_..._.. , s� M
J .. �.j
Floating Platform(s) !► .-
13'x i3' 6 /
Finger pier(s) ` t I -k l-- S E
Fca j� • 'I curs''-'=9 tzrr Y
Total Platform area ''''\c' 4
Groin len h # —\ t �'� " _- .-_-L--.�'
Bulkhead/tR prep length —=- - • t_ k I"
Avg distance offshore — ---- i
Breakwater/Sill
� I
Max distance/length I 01' ',) I
Basin,channel ' I — ., -
I .
- j._.. 1._.--- } __—
Cubic yards et,t si.1 ,:y
Boat ramp i ~ G kr-41 {y
Boathouse/'Boatli , /3 ,' S
Beach Bulldozing 44• i--- -- Je"
Other _734 r�'1,�fv t/�}TE� A ' -■- � 1 - -•J T i __— --� - �-----
r L :
SAV observed: yes ; I R(:i-'
1 -,?--g- i i
Moratorium: n/a yes , f a { -P(ZSZ )
Site Photos: yes o ------- -...---- -1 - --_ •j_ r --L- -- —
Riparian Waiver Attached: yes 1 i 1 I
A building permit/zoning permit may be required by: GLvy, o f F5rrl
y `. n'TAR/PAM/NEUSE/BUFFER(circle one)
r Permit Conditions 1'6'Viel G, i:.. i" 1'ir" olZ•,rn side,- ‘/Ci`1f
,- 1-'.1 r7 V-.4,-r.\ Lit,r u. k! !, /-t-e• 5 'ern/ < N...{- El See note on back regarding River Basin rules
r 5 I.ef/01,J✓'f cv t bJ ? .1,-.a[ 5h' . •</ /7 /3 x 1�' 1 ic. ) l•,l,t .
1 El Seeadditional notes/conditions on back
/s-,,:, ' -.n ;,011/ hate,- . : , 1- # ./ • ,,\ ky, : ,
--- 1,, ,; 5 J, , , . . S I. r2 - C2,4 r .'
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 ` J
iiii cccJ"aii
Signature**Please read compliance statement on_back of permit^• Signatures
,-' • ; r) . .2000-i C. ,_71 ,4 - ; -i^-`- - 3 'S,-., .- ?c32-2
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

S�`°�'"`
: c CAMA ] DREDGE & FILL f C1 (1( i No. 84940. ABCD
GENERAL PERMIT .� Previous permit
Date previous permit issued
I I New I 'Modification I 'Complete 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:
ISA NCAC Rules attached. General Permit Rules available at the following link:wvwv.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s)
Phone#( )
Email Subdivision
City ZIP
Affected ON n EW PTA ES PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): Li OEA IHA I I UW SPIMA r I PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: )
Shoreline Length
Access Length r`1' •' " *: —,----
Pier(dock)length ,t (--. . .� 7 + z 17 I
Fixed Platform(s) �'' "7 K \ • '•
` 1� j,a rhk_.0 F P_ " . 5
•lier •
IT
'tit 1 S
Floating Platform(s) f L 1
ir:4si„t k - �_,, ,
Finger pier(s) 1 t i 1 ' _
• �jc �� 1, . ::: ,......,. /
4i lit., , ,..,......„,
....... .
Total Platform area i i`'f j I I j
Groin length/# t .;i I. �///r.-- 4 ll `
•Bulkhead/Riprap length — F=----- - --.--_..___. _. .
Avg distance offshore • - ( (..
Breakwater/Sill I +.0,f / . I
Max distance/length ��' ) /
Basin,channel j ,�, �. I I
—
Cubic yards j_....._.. !
Boat ramp t (tvLv-�'+-', f
Boathouse/Boatlift I
Beach Bulldozing ""�---_ I ` I L I
T r .-,. - S1 �.
Other r1_ 1 I __-_��..____._
1 .-. M ��t Ts
SAV observed: yes no } f5 I R t 1
Moratorium: n/a yes no , I I "'�
' - ( ;.'.
Site Photos: yes no I i - •
Riparian Waiver Attached: yes no 1 I i I
A building permit/zoning permit may be required by: , 1f�
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
. f 1 See note on back regarding River Basin rules
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 r
y,
Signature"Please read compliance statement on back of permit" Signature
7
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 B sin 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

j ROY COOPER
.;a
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.
® Pre-prof ct site conditions: ZO+ 1 1 " 1r /á( e G.,•ii
a .ew 'r(.es
By your signature below you agree to be held responsible for meeting all of the conditions listed above d v .fy
that all information provided is complete and accurate.
gi-,(4, /r--7. ..„, , 4,, 4,0 4., „--
A n or Applican rintk Name ermit O er's natur
gent or Appli gna re Issue Date
CAMA GENERAL PERMIT#: qqO
State of North Carolina i Environmental Quality Coastal Management
Washington Office 1 943 Washington Square Mall Washington.NC 27889 i 252-946-6481
Wilmington Office I 127 Cardinal Drive Ext.Wilmington,NC 28405-38451 410-796-7215
Morehead City Office 400 Commerce Avenue Morehead City,NC 28557 i 252-808-2808

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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)
Name of Property Owner: ( /
P y T lit/ �/ih i/v/7 r� 4, rJ/ .
Address of Property: 4y9 B/PAL d /441 at 4/(
Mailing Address of Owner:` "get)-e
Owner's email:d o/A)4 7e,r e Ze,,,n G_ Owner's Phone#: 9/7 • �li 7-(A7h
R 4, , Cio -
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
1 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 set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement(initial the blank)
/
Signature of Adjacent Riparian Property Owner: �n r____---
Typed/Printed name of ARPO: 71 on-,uf 1?occ /KIr/S
Mailing Address of ARPO:: (92"��,.� y jc(u Eh ,JC v;e t.-- '{G IA VC 2 7 30'
ARPO's em il: nth:I15 Q/Gvuti.-mo*tARPO's Phone#: ci f l/sa/L(
� 1
Date: 207 1 *waiver is valid for up to one year from ARPO's Signature*
Revised July 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 completedby owner or their agent)
Name of Property Owner: (JDh Y QQV / i ) J/,0A,/� tilt-
Address of Property: 79� (��/��, eei 3 (//erg 4q ( /l..7 �-no '
Mailing Address of Owner F n/./P.
Owner's email:don.) JZru f //44/ Owner's Phone#/9/q)G67"5-076
Q Qn.. 4 . v ap^4
Agent's Name: Agent Phone#:
Agent's Email:
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.
4 /� 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 set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revet i-nts). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15'setba. z�a __
Signature of Adjacen R;.arian - operty Owner
-OR- p
I do not wish to waive the 15'setback requireme ' 'tial the blank) hn 1,
I A v J
Signature of Adjacent Riparian Property Owner: IMM,f c., . .160
Typed/Printed name of ARPO: riPaak C.I A \fc . {/v <ci 3 F I L17
� '7
Mailing Address of ARPO: Ltc- '--B ZC \Pi F�I,Lj
ARPO's email: �l fNlUt '.�Es PShone#:R 5 a -
' --3 a n 7
Date L Bl t .Z *waiver is valid for up to one year from ARPO's Signature*
1 Revised July 2021

. .
TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to)the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area
along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development;AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development.This
might include street-ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families),send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.00v/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to retum it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 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)
Name of Property Owner: 049,4 r e,� ��i�.f/ (77;
/ G
Address of Property: $99 r� 9QQ N&t-/ aPel 4e 4 NC 2Tyoi
Mailing Address of Owner: 44 c', //
Owner'semail: )1 147,m Ayey r�(�*Owner's Phone#: 9/f 7��7'
4."; /, cow
Agent's Name: Agent Phone#:
Agent's Email:
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.
A, 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 set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign_
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback "IL a /)
Signs ure of Adjacent Riparian Propertyer• !�
-OR-
I do not wish to waive the 15'setback requirement 0Jlt
(initial the blank) 1
Signature of Adjacent Riparian Property Owner // { a •/�Pn _ -a-A
Typed/Printed name of ARPO: ST61°NfW P afu (i4YX &fe l
Mailing Address of ARPO: h'#5 &101 sE.940/ VAO,. /SIN, A)e 027s/
p v j t ook re"-
ARPO's email: STFu,E pfi 4 0 Sra ARPO's Phone#: a sod— to 3-OCoc
Date: *EA/a if *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to)the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area
along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development;AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street-ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families),send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.aov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 2021

Grandy, Ashley
From: Bubs Carson <[e-mail]>
Sent: Tuesday, February 1, 2022 7:19 PM
To: Grandy, Ashley
Cc: Town of Bath; Chip Edwards
Subject: [External] Bath Creek Proposal - Lyon/Persche
CAUTION: External email. Do not click links or open attachments unless you verify.Send all suspicious email as an attachment to
Report Spam.
Ashley Grandy
NC CAMA Permit Officer
The Town of Bath is aware of the proposed modifications of the Lyon/Persche shared pier in Blackbeard
subdivision on Bath Creek. The elimination of the slip at the end of the pier and the installation of a boat lift on
the north side of the pier is consistent with the Town of Bath ordinance. The result is no net change in the four
slips in existence.
Thank you for your assistance in this process.
Bubs Carson
Town Administrator
1

,.. copy
TOWN OF BATH
fr
BATH, NORTH CAROLINA DATE 7' 20' El ltc'A
BOOK NO. PERMIT FEE 5U# PERMIT No.
APPLICATION FOR: BUILDING PERMIT( ) ZONING COMPLIANCE CEERTIFICATE (
Name & License No. Address: S99 e 2 Phone No.:
l/ ���� / Ueed 9/9 4,67-SO7e
OWNER
719 4 I4 , ,as 4/'w J,4.
CONTRACTOR
DESIGNER
SURVEYOR
ELECTRICAL
PLUMBING
TYPE OF IMPROVEMENT
NEW ( ) ADDITION (✓f ALTERATION: INSIDE ( ) REPAIR: INSIDE ( ) MOVE ( )
OUTSIDE( ) OUTSIDE ( ) LOCATE ( )
Lot No. Block No. Building located at 5-9°I Blac .e.curett
between and Streets. Building to be used as
. Type Construction c c X .
Number of off street parking spaces . Contains rooms and bath(s).
Total square feet of building . Electric Service
Type of heat
. No. of plumbing fixtures . Foundation block caps
4" ( ) 8"( ). Corner bracing: Plywood ( ) other . Insulation: Floor
Walls Ceiling . W'•sows: Storm ( )Thermal ( ). How many exterior doors
. Water Heater: Gas ( ) -ctric ( ) Other
Roof Ventilation: Gable ( ) Eav-. ) Louvers ( ) Other . Ventilation
crawl space, number of f-- apart . Height of crawlspace under house: 18"( ) 24"( )
Other . one , Water and Sewer Tap: Paid ( ) N/A ( ) Size water tap
Size se tap: .Total Estimated Cost Flood elevation

3
BUILDING INSPECTION DEPARTMENT COMMENTS:
12L-A&15 GALL weer— AM. Am Mau U2'A I6 017 E 111o2T7i 51•d>E of
E1.15T71-16 r -& . A Box L(G'T (/o KZoto* to x ZS ') is
I1.15YALLrad ',L.151DE I Try . LL Goio .uCrjoiu wict, Be
lop ' i=QOM k1t4.474 '2n 7 ouuvst/v/. L� � �,�
Au st ai'rrn4o. co Ib�y ,N sr C�/df°L [Jl A/Z4frs A /ZE45 .
GENERAL COMMENTS:Rep i44 5 Cplru• C4wscw 4 r VOSC3 c C 1 4
(a?rrv), to km ')
CITY LICENSE NUMBER:
Contractor/AC Electrician Plumber/Heating
Application approved by: .c1 dam( • 7-Z -Z 1
The owner of this building andithe undersigned agree to conform to all applicable laws of the Town of
Bath, North Carolina.
f H-/'7'
ignature of Applican
Effective 8/10/04, there is a $50.00 filing fee for all permits, including zoning compliance application.
Any construction that requires installation of water or wastewater services may:
A) Be installed by owners, contactors or
B) Be installed by Town of Bath Utilities Department
All components must be compatible with existing water/wastewater materials, including Myers pumps.
Bath Utilities Department must inspect all construction prior to services becoming operational. Inspection
fee is $100.00.

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