85071_Sephen R Sruill_20220209

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ziCAMA DREDGE & FILL GENERAL PERMIT
N9 `�{)I! A �j C D
gi
Previous permit Ned
Date previous permit issued Nv'�
New ❑Modification ❑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:
I SA NCAC a 3 l-1 , 1 c o C- ❑Rules attached. tN General Permit Rules available at the following link:
T�rlv!'N1�art 104-
Appliaxtt Name �QP he n � _ cy1�r-►a; N� t�iE._1. Authorized
Address 9`;2 RidVs R..y `2. 1 Project Location(County): T/( e e 1
City i!- O�f,tlyl l7)et State /V C ZIP a 9c 5 streeet,Aadraes S Lot (a)I^n4)1 Y11 (:- S/
Phone/( 2) 394'/ - /3 3 - qd,u Legit YSS BG‘1(< {�rC
Email 9Spru i lie CCJ•t4"vir y l I..�l: , C c/rt _ Subdivision jC.,Ik S lc-,y
City C'(�lL,Nr1�ti� ZIP . 7 `Ias
Affected El CW IN EW PS PTA W ES 3PTS Adj.Wtr.Body MGM ''/- (1i i U e FAA ea i LA. (na )
N.
maw: ❑OEA ❑IHA III U W ❑SPIMA ❑PWS Closest Ma).Wtr.Body !I ibeIyW IC 0:A %0
ORW:yes no PNA:yes ) n 11
Type of Project/Activity i� r1Zea Mbr X 2C 7c .. 3 ell at) /'hc3� ac '5
C 33 y> ') (Scale:it//4 a
Shoreline Length f--(ft--)C)r 2 .
Access Length gl IIt,LS i
[� 1' 1,
' N
Pier(dock)rm(s) h ��y.` A,L%�
Fixed Platforms) v
cf1- -, At. (43 ik4- fiker• (
Floating Platforms) ' te rlI � {�`
!` S'• iJ J(il,
reaSS}4
Finger piers) . .0 tbi42172M, -s-)ff
Total Platform area '.(ty 7'54 I • > ��
Groin length/0 ► + ;f ���� 7 VT'
Bulkhead/Riprap length [ i
Avg distance offshore `•� I0' kr
Breakwater/Sill Cy J i� J
���O�
Max distance/length Ae f
..khannel /6E)X Z1)X" 7j i� 0,
Cubic yards 33.)( '-S ie/
Boat ramp I
Boathouse/Boatlft (
46
l CI ..
Beach euldozing /
III
Other Ci
SAV observed: yes (+
( 4
Moratorium: n/a yes �1.-,^
Site Photos: yes -`
Riparian Waiver Attadred: yes T 1 Q }�v.
A building permit/zoning permit may be required by: y't/e it Cu.v, r' 13u LL•S �' l/ rx
Tit. ry ❑TAWPAM/NEUSEBUFFER(drde one)
Permit Conditions ��
se I r ti cay.+. a. tT, i)Cvw d ICC r E 2 c ❑See note on back regarding River Basin rules
cL[ �PX C a � �D
1) ez-ige 10 d b,` )5 j..,y r • / - .5.pi 3Z El See additional notes/conditions on back
I AM AWARE OF STATUTES.CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND VIEWWD COMPl1ANQ:STATENI NT. (Please Initial)
-e &, (Jl
nt PRINTE Per s PRINTED
r
ur g,••Pie d cola state a of oily:
zip
Application Feels) Check N/Money Order Issuing Date Expiration Date

,
NC Division of Coastal Management 1713 7 A C I)Cashier's Official Receipt
illill
DateFb 3 20 Z-031"--
Received From: S6016$'1s i
S 9D r p o
Permit No.: Ii v ger 1"1 ' Check No.: 16 5e
Applicant's Name: 54 p Sp(lI1 er lek 7)04)61714r+ County: 'Pre.if
Project Address: (1" blA i I S BQ y ge 1.61 C(/41 ` C A
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
Signature of Field Representative: Date: Z/fS/Lz

`°"57.41 %CAMA X DREDGE & FILL Na 85071 A j c D
Date previous permit issued Nif Or
PreviousI permit N1 J
GENERAL PERMIT
New El Modification 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:
I5A NCAC CD&1 4 • SCE 0 ❑ Rules attached. NI General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant pN,ame S+ 7 hen 'r _ . p rt�t (• Authorized Agent 4 /
Address -I 3 7j _gc�11 s R o.), 2,.., Project Location(County): / C -e l I
' /� C. ZIP . 9o2 .5 ► i�t- ry e. S�-'
City O 1 LA�Yl�) State Street Address/State Road/Lot s
Phone#(Z52) 39Y - c/ 3 3Z Gt., yccehf 4t. Q$ &3 . llr ReL5
Email S Sp 7-LA 1 I 1 e c wry I I.u k.:. . C OM Subdivision t.._ I.` 5 lCcz y �1
City e J ILA.inn ij 1 vc
•e, ZIP 7 9
Affected ❑CW EW (PTA 'QES tl-PTS Adj.Wtr.Body l l p, - fr.()e S i (na an unk)
AEC(s): �❑OEA IHA ❑UW n SPIMA I I PWS Closest Maj.Wtr.Body / I being II`(- s VAX'L'
ORW:yes> PNA:yesao11 /y)
Type of Project/Activity A CrcZ€1. 0,50' X ZO X - ' CIti inc/ ,, c c� —5 ,
(_?,3y � (Scale:,f/r )
Shoreline Length ��C,:' 4 `
. fi
Access Length 19 114
I.
Pier(dock)lengtheiP__., �„i' ikr 1�i
Fixed Platform(s) ,Acl- 1 jejle.idt-4,- +. `
(/Floating Platform(s) y *,11
N
1ci, 9'. 1 c46
Fingerpier(s) _if � �'r' �j:,, a , .iciet 2Pc z
vit
Total Platform area ' t A'A 0 id Lic
Groin length/# `t+ 1Z p 1
Bulkhead/Riprap length j��
Avg distance offshore ,�` ,� el �/ �.� CA--
Breakwater/Sill , .0W;y f/
Max distance/length 0
asin hannel /rja A Z X- ! ' ��
Cubic yards �3�Y�3 4%4
Boat ramp // Q 2Boathouse/Boatlift r p' (6
Beach Bulldozing !— E
Other 1 *E
le6
SAV observed: yes
Moratorium: n/a yes 4�. _AZ?
Site Photos: yes ilariu C/07
Riparian Waiver Attached: yes `a. 11 1
A building permit/zoning permit may be required by: 'i'e-6 1 ��� r 5 ��v/ ��
�,1y J TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions "D 'TL L h✓k `-. c-vG"�f(�
1A)1.1k qLt sfX CCtvs -j ,n b 4 1-D - c.)CQ.,c1 l y)3 n See note on back regarding River Basin rules
_771a mot I• li o arc g 1.-,� F. =, .. t s' - scpt. 3 a
n See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT ANDn VVI WED COMPLIANCE STATE1tNT. (Please Initial)
Agent or Applicant PRINTED Name Per 0 c s PRINTED e
Si ur "Please r d comg, an statement on back of permit** Sin ure
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 Wilmingtyn Regional Office (910-796-7215).
Notes/Additional Permit Conditions: -
l
•
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

0°A44s,Ill CAMA 11 DREDGE & FILL N° 85071 A g C D
Previous permit
GENERAL PERMIT Date previous permit issued I,
g New 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:
I 5A NCAC C I-1 , 1 C-0 O ❑Rules attached. PI General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant�Nyame ✓1 -er7 e r' ��Y�r�A Authorized Agent �a /T
Address 3 , }—S lt,c( S R.y i2 t) p-7 Project Location(County): I y 11 e ( 1
City J‘U rv, - i/t State P T:>c 5 Street Address/State Road/Lot#(s) GN - Y)14)C f -*,
Phone#(252) 39'/ - 51 3 3 c,e). yea <<hi k (f 33 Qu 1It Ra5
Email 5 spY(.c t i t Ce4--ktnr y 1,...L..- • C oM Subdivision Iity.._.I` c
City . 4 4....4 rt�1 h, ZIP ,� 7 k1
Affected 0 CW E EW PTA n ES Fins Adj.Wtr.Body MOO IG O " m 1!i t 'c S i=' (na nartlunk)
f) \
AEC(s): n OEA n IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body ,fA lbe( r[c r�Our
ORW:yes/no PNA:yes/no
Type of Project/Activity 100 or l;Ze l I5 X 20 x - 3 d01 Ale I J✓y7G'i>1 c\e j�`L +c
(2, y \s) (Scale:AJ/A )
Shoreline Length + 47C0 S i 1
Access Length ` on. . a �. — ---_ .._.-------, . _-
Pier(dock)length "' f s ■
Fixed Platform(s) 1
f
1 MIA 1��►I r !KA , it
Floating Platform(s) tr. ��✓ Wlh( �� r��� ��_�iniiiiiiiraprennirr
i *limo"
Finger pier(s) : ' .* f „P &U� riaglirirmi.
Total Platform area j Al t ■' ' L �— �
Groin length/# T.-( �; --
Bulkhead/Riprap length f_ . .___ S'`. '. �' i _—_-- EMIAvg distance offshore z C� j
in
Breakwater/Sill , J - ' i ,
Max distance/length ' T
'rasi channel it:).K ZIX " S _i_ - 1 4 .._.._.—r- f
Cubic yards • "3 y� ' 1 j iI
Boat ramp ( n
Boathouse/Boatlift ,'1 i 1 I D
I j 1
Beach Bulldozing ______ 1.41.,...._ _ _______ 1 . ,
j 1f
Other I 4 -
` j
1
SAV observed: yes no �` _�_. __._.�!- -.-__
Moratorium: n/a yes no '� i 1 i
Site Photos: yes no I' �. . i --
Riparian Waiver Attached: yes , -fto' �-. `, / ~ - • i le �� I I I
A building permit/zoning permit may be required by: / 11( i l` L (?� �1k •--��'(5 K.
�\� --
Pe/r�mit Conditions �'(-ID --, Y1 p-{ j'"� / el,Ce- J t O►'+ '- `-5 t-++'-I' 15 TAR/PAM/NEUSE/BUFFER(circle one)
flip i.,,A t„be t -fx(a.'.• -I c4-. D t 'r-D ' t)Cvv:\_ IccV y v 3 d c n See note on back regarding River Basin rules
tral-rf I A I-- O �r e-\5 I—5 c - !5. — S.-pi 3 n 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 N e
Si turg•*Please r d com anc stateme23 on back of permit** Sin ure 1
n K Pry �� .� ; ,, , -e - . 0 •z - f .5,,„-7 - P'L.)7 1..
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

�°``°"""� CAMA DREDGE & FILL N° 85071 ABC D
GENERAL PERMIT Previous permit
11
Date previous permit issued
New Modification Complete Reissue I 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:
I 5A NCAC t't , i``�C.-. Rules attached. General Permit Rules available at the following link:www.deo.nc.gov/CAMArules
ri Applicant Name ' ( •,-1 Authorized Agent
Address -� r-,. Project Location(County):
-1 '} l:`
City ,_fro 1--�) State C. ZIP , Street Address/State Road/Lot#(s) l 1r
a`/ ' r,..1(,: I
Phone#(✓') '.)c'i tj - _R+ gc., I 1 (' Rc 5 < ,\
Email , , \\ / I ' - 'tl', Subdivision
City ZIP -) 7 '7 .A'c
Affected n CW I I EW n PTA n ES n PTS Adj.Wtr.Body - \ (na j ii$unk)
AEC(s): I I OEA IHA UW I I SPIMA PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:1yes/no
Type of Project/Activity ,' _ l k� ,( t7 4 OC)1 "(' 7r) "c '. ' �a4v/PrC ,
6 7) (Scale: )
Shoreline Length - i
Access Length yi,t _ I i i •
E ` I ~Ni
Pier(dock)length
Fixed Platform(s) ��j - 1 f `�• __ -- _1
illtFloating Platform(s) i '• -°' *l'ir f< ' L i�;4
Finger piers) _._.__.` 1 !..._.... ..._._
1.
t {^ t
Total Platform area_ \ a t -' + 1 - I 4,�79A Y .
Groin length/# t �_ R • .� •�w _ �� 4
Bulkhead/Riprap length I Ell
1111
Avg distance offshore 1 • '} . ,g - ; -,c)c- -
Breakwater/Sill � f I
Max distance/length ..' '
Basin,channel __.
Cubic yards J>r t[YI
Boat ramp .-J i i I
t
I
Boathouse/Boatlift i I j { -�
i T
Beach Bulldozing I Iile
Other j J
SAV observed: yes no i I R
Moratorium: n/a yes no ` tr~ 1
Site Photos: yes no -.1 E -- �—t ---- - _. .._ I
Riparian Waiver Attached: yes no ` 1 ...-,-......--
i
A building permit/zoning permit may be required by: y(tE `i I c..,A;,1-i ! . t t
�- I I TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions t(' � f r Y.; � e C ..,<- \4•> <-�. +'")g ,
. , -; ti; , -1 ... r'1 „ C 1.-x. r)<v ' ICrA')y.1. ; 2 c'' I I See note on back regarding River Basin rules
i \v /< " Ce•pi . . 6
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 tx
Signature**Please read compliance statement on back of permit** Signature
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

Wednesday,February 9,2022 '
I,Glen Davenport,am aware that I am a co-applicant on dredging the canal on Bulls Bay Road.
,G G/h/La 2 Z.Z ' .
Signature • Date
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: /Stephen K. S priA t t I /r
Address of Property: CI 3 3 Bulls k x/ // Rd Col'^urm he a, INC. 21v`2`•
Mailing Address of Owner: /2O& O T1(av 1 s PC( Co\umb1A, !V C 2ng2 •
Owner's email: SSen t tacef rtury I►aOwner's Phone#: 25 2- • 3q4• '-F 33 2.
•Corn
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property.The individual applying for this
permit h s described to me, as shown on the attached drawing, the development they are proposing. A
descrip on 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) t
Signature of Adjacent Riparian Property Owner:
e •
Typed/Printed name of ARPO: // r (� ( PO
t� A �� 7 p,
Mailing Address of ARPO: £b J I✓c' IIfLh RI) /�)UFti l c /IJC. G 7"i Z�
ARPO's email: ARPO's Phone#:
Date: '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 NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY •
•
(Top portion to be completed by'owner or their agent)
•
Name of Property Owner. Sieph-erg 12 Sprutr I
• Address of Property: q VI e?)1.4.1 5 Ray QcI C,olta mh;A Arc 2'1G 25 .
Mailing Address of Owner: \01 Leg► On each t?cl CdOkLLVY0btG. Y�lc 2i g 7-S
Owner's email:3s f r ;11eCerThkrylihK• Owner's Phone#: 3CI Li •y332-
na+
'.Agent's Name: P1Sh\ey Q vatic(, Agent(?hone#: 1.52 • 0142.359}
Agent's Email: ask lei. 9ra vt1 Co hcclenr. Gov
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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. •
1/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 M.O. 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
4notified 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 tp 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) �c7- v
Signature of Adjacent Riparian Property Ownet:_ tA.,
Typed/Printed name of ARPO: 1 le iJ ,) n jf e-/vI 7 J R.1 11
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Mailing Address of ARPO: £5 �� Zo /1 S ,1 /9 (� 69D,'u ) (4L re
ARPO's email: ARPO's Phone#: �.5 - / 7 9 rJ
Date: Q J' 94- I *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
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
y (Top portion to be completed byowner or their agent)
Name of Property Owner: 6 fep hen IQ S p rui k 1 I ,
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Address of Property: 3 1 11 S Qrj r,oLtryoo;[X. NC 2-1 OI 2 5
Mailing Address of Owner: t 0 I Legion t�' e ct c v- P d r',o\u.rn\o i cc ►` J c 2, G-15
Owner's email: SSprutIIG,cen-l-t�r1l;nit.pwner'sPhone#: 152. • 3•=%1,-•t • `t332
Agent's Name: -Ashley Gycc.r'c y Agent Phone#: 2.52 •of`t$• 38 `I
Agent's Email: 0.Sh I e y 9 randy e r\cc1 e rl( . 30 v
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
descriptio or drawing, with dimensions, must be provided with this letter.
7I 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
(thj,s 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 C
Signature of Adjacent Riparian Property Owner: te. j _ -.,_____
Typed/Printed name of ARPO: 1lA 2 £ 6 o (r 4 c'S 7
� (d
Mailing Address of ARPO: , )f 1/ %Eli/ , /r,Scf5cs71, (.(/J :'L
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
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