85139B - Killette, Debbie

,/ 1
dt°"W L` CAMA U! DREDGE & FILL /`�[� No 85139 A C D
TP 7✓ / Previous permit t-I t'4
4 GENERAL PERMIT Date previous permit issued OM
(g ew 0 Modification ❑Complete Reissue ['Partial Reissue '
As authorized by the State of North Carolina,Department of Environmental Quality and the Cn+ al Resources Conenisslon In an area of environmental conmrn pursuant to:
ISA NCAC O4It• t I 0t ❑Rates attached. General Permit Rates available at the\\ following linkypie.deonea 0�
Warne V
Applicant Nane1ob(e. t<(1\e2?4e Authorized Agent ftP.Ot►,6illi• (lowfrac4eeS
Address 2100 /Cary< Ts-e`ata Pro)ea Location(County): flail Ai ing eir
CityN tcsope - State C ZIP 21-4 1-4:, Street Address/State Road/Lot i(s)
Phone 0w 'Y ti p - l 1 SIOb Lear ys • %eacL,
Email b e e4(ryslSPs.tin . GOWs Subdivision N/I11
City Roper ZIP Al-91.0
Affected ❑CW [ ( E A Ers Erryg Ad).Wm Body Al toter,cceL Sot-gr enan/unk)
AEC(s): ❑oE* -❑iifA 0
UUw ❑SMMA ❑PM aosmt Ma).WM Body till ocn-,a eL Sot....,,.J
ORW:yes/® PNA:yes)
Type of Project/Activity Zjfl N is: 9sy 0 9 m!w , a a YYL•n,i o F' 2r l v.kwsr) 0c
'ex`sH1 $iaWe al4Isial • Startle&e ci pnlx rot' F.P v�77) �o�wt (scale:l"-Set'
Shoreline Length t f .fir 7cai e'- _ .atanA,�-� .f."iq It a' fights( r.eb.y .s... „
Access Length • .' ., - . ( '
I.,
� .iAl be►rk=r2� ��.,..,�
Pier(dock)length i- ' . (, i , i - ' . 1 I.• ` '
. Fixed Platform(s) . . t 2 L. ! , i . i I
Floating Platform(s) . . ' ..�•.'
I i
Finger'sleds) • j i I -
i.
Total Platform area
Grooin� �
lleern�gt�h/A .f_ f_ ..' i 1 -.. .
V 13 r.�!prep length 'F ,--, t ; i. ,
Avg distance offshore =. i - `. : ' ® '
Breakwater/SIII # ti. f'r N f s : ; r rr .
S i _S�. : 1 I L. .
Max distance/lengtli
Basin,channel I I - • 1 . : ! Ie ettdFt• t Sc ' in' ,hulk a'a I
Cubic yards •
c�i 1 , ; 1 i t-
it Y e1! r� k
Boathouse/BoatliR ! i Boat ramp } E IN4/ a a ' ; I I�,-yt.6Cm, r 4O ' tDWY ✓1r"0 .
Beach Bulldozing - - ' .. {D ys'R/Na\✓ - i._;. ••- .ifd s[I^J . _ . _I- I-. -
Other i ..i . 1. . i `. . , -ami• : , I._i
:` e 1 Ck••il7” R4l(,rle+'1e4 : 1p�ylm_`\y`I .
SAV observed: yes § f'pvitn l , ' LIMP : • . ' : • :,�111 . Urn
Moratorium: n/a yes t 1 It �c6`^ _. i _•..a _
•
Site Photos: ? ��.�,et �( p Rom^ • ifi•,
Riparian Waiver Attached: reed no �� { 'vose'a, "1-rl�' �I _.. )-� (�
A building permit/toninggerml jnay_be required S L,
Permit���Conditions `. T �-i `` St/ 0 TAR/PAMJNEUSE/BUFFER(circle one)
ITV I to L7c Z fNdti�/✓ar O o c �t c f i •� 1.-6,/ ❑See note on back regarding Myer Basin rules
,r�f . t52r oF' marl In Tic t'JU9 leap f-
r c-n rJ• Rp �IGp nb-� I�• Ate ❑Eeeaddltlenalnotes/ewMltlonsanbade
4l1 t� WOW( pie l PO apIJ (r�°' % oe- km
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS MAT APPLY TO THIS PROJECT AND EV ED COMPWy�NCE STATEMENT. (Please initial)�� _r)� (A'1\1ian . f5I1l� fo �nc�y
Agent or Ape ED me P: O•'cis PRI a e
Si to •• ppgad co li ace statement on back of permit•• Signature
'�DD•� Ic4aq 2-2"- Amt. -2oLt 22.- -u -2On.
Application Fee(s) Check A/Money Order Issuing Date Expiration Date

it°*t°"Tk CAMA I DREDGE & FILL N° 85139 A Z C D
a Previous permit OM
GENERAL PERMIT
Date previous permit issued p,l9
[4lew ❑Modification n Complete Reissue n Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Co tal Resources Commission in an area of environmental concern pursuant to:
ISA NCAC 01 rC' 11 D0 ❑ Rules attached. I YI General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name T,ebb t e h;`Yek-C€- Authorized Agent C)CP �
^1 Si_ eJ toCOY- aG �C'S T
Address SLQC1 t eaYV S ?)efsiC\ �y Project Location(County): L& r1b i iYvcj�r
City P.0p2✓ !State NCB ZIP P T-1 Street Address/State Road/Lot#(s)
Phone#( ( a23- i3 f blob LaceryS ^ 0.ck
Email LA.)1 t d-t eegryS 1�erx c , COYIn Subdivision NO:\
City Rdpe-r- ZIP 21-9-4-c,
Affected ❑cw -W PTA ❑✓E. I'I pTS Adj.Wtr.Body A kV,e w.etr,t Sc.t.,s."3 na an/unk)
AEC(s): ❑OEA ❑IHA fl UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body ‘vCPs— L . S o yy,
ORW:yes/® PNA:yes/p
r I��(�
Type of Project/Activity Z Il I I1 fi l93 0 f , ew it r[r��"t A a )')-btu o F Z' L'o Ua-r) d,�
'e1Ck Sh'st S 6 c a br4. i temAn• Qefr to e & )r1 2' o.F' t(,Atesi e o k'� (Scale: 1'`-3�Ir
� ! 11
Shoreline Length ? Ijt.-)kke (�(.&i- j i ti S�1 e 1�r c+a 1 k rt+1..rt,..r
'AA ,fe SI4.tiJ
Access Length ffl�+'Ybc
Pier(dock)length
Fixed Platform(s)
Floating Platform(s) (
Finger pier(s)
Total Platform area
Groin length/#
ulkhea iprap length 9 S a _
Avg distance offshore ; S )--j v.5 t -
Breakwater/Sill
•
Max distance/length iD61.4 f
Basin,channel �.• ' r EXiS�'NS. �` « h�(k1'Tco� v�
Cubic yards
• r o ,..3 k
Boat ramp + g,}cLlcbkga .t9, t'v,StxLI ± ,c Zr a ll g 'n -
Boathouse/Boatlift b1 �e p' 0 5 5
Beach Bulldozing it,
Other jr �;JMN�
MM..T.tI �'-V`1_
1 G C-LL . 5 SuLK
SAV observed: yes ® co ea// zr1�vIim ,�. 111 r, 9a v�PW
ui
Moratorium: n/a yes '_ 7.
e2 M
Site Photos: yes �pco? t�.T� K1 I,>G C Pib 7
Riparian Waiver Attached: da no /-
A building permit/zoning permiitmaay be required by ulst,,L49b, 6,
Permit Conditions`pa, T/ 1 !.s pia 1 h' 1�'G� f 1 ra1�✓�'f / i v,/ u fi (} TAR/PAM/NEUSE/BUFFER(circle one)
net— fb i'x Z l t/,d}"v&✓a -e a Q- 144 t f..mC)-I'^, 1,- 4 n See note on back regarding River Basin rules
at poi-if . i 521 o f wa/I ki ,)c. au, 4 cr f
J ❑ See additional notes/conditions on back
s Lola Wa--crw� , R-pp)m molt no' � �pla[.!' qew
k1\ i� m'c O� e011apc€J To,ti' o� wall .
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND EV EWED COMPL, NCE STATEMENT. (Please Initial)
3 foirie--)y
Agent or Applicant PRINTED Name P- 0••cet s PRI Na e
!e I
Si toe"Ple a ead co liance statement on back of permit" Signature
#y00-� 1 c qal 2-2--r are)... -20Z2 Zz- -5'LAky -20ZZ
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

it'“ � DCAMA 1-1 DREDGE & FILL Nn 85139 39 ABCD
GENERAL PERMIT Previous permit A Date previous permit issued l
[New I '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 SA NCAC ✓'-1 ! . n Rules attached. n General Permit Rules available at the following link:www,deq.nc.gov/CAMArules
Applicant Name Tic''4J\rs 1 c • ,. Authorized Agent_ • r-,5.,<., _ i . 7 r.( • i
Address '' . ;7 / kr t y c. SY=,•- 1-• Project Location(County): A\ ' < - ,•,cam I'D,"
City T State t•.-)n ZIP 1-y 0 Street Address/State Road/Lot#(s)
Phone#( • ) - - -7 1 2 ,t=ra c
Email • /// -
;`'si ry.� u' • 1 Yv- Subdivision
City ZIP L V
Affected ❑CW (nEW [JPTA [ nY1,Ts Adj.Wtr.Body - i r S o,,.,.r.1 wi/unk)
AEC(s): _OEA ❑IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body • • ,-- ;_..._.
ORW:yes/no PNA:yes/no p
Type of Project/Activity 1YIs /( - /-5-I d ( y7,'Gr tjL,l t j-1r .)i c ,r-v:s,t o r 7./ v•1--(.Z.Uo" <
12X‘ s h"'Cr S�4j r C. )1r Me ik • e rr(Ad r PO b)L S 2 ' . F- tt;a P'z a vd (Scale:i•'- Sl
Shoreline Length * T c l c...)k('1.', tiL_k-j- ; , ,.� .,1( -F I 1 �L i 1 C - -L.;ii—._t
Access Length i 1 ia'/y�r I, Sor J
Pier(dock)length r ! i
Fixed Platform(s) 1 ! _
( t j F
Floating Platform(s)
' -}-
Finger pier(s) , I- ' 'i " '
Total Platform area 1
Groin length/4
Bulkhead/Riprap length • - ----- -, i ----.-- -
Avg distance offshore j . y S ;• ` yt 5 I•
Breakwater/Sill
/ _A 1, 1 J
Ct-. '• •1 Max distance/length , 1 •1
Basin,channel — r-- --• a----i--•1 1 sK--rEX'$i'"` S - e-r-4 I I7NIteVK 4 r
Cubic yards -1--* �•t,irei t
Boat ramp 4 ry 1-lz tea`,, v — `mo t r, C �} �j�� �I
Boathouse/Boatlift j J" b1�j w° fi J r ft 4 S`T
Beach Bulldozing �' h� re
• ll
Other
�Y"
SAV observed: yes m ---- i, G
Moratorium: n/a yes • ' e_, '� c , 1 ���r� � .M (
Site Photos: yes ho" , ,?, ---_ —=_ 4 r_-i Ki}l- b l v �
Riparian Waiver Attached: yes no �_t.1,_ r 1 'r•e'.►"M . I I)
A building permit/zoning permit may be required by: t�t�- II jNG/ i,
A , . , ri TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions _ (l k-^C J ',i ki/?, ;`, LA/w %7c,/r\I l r,l/!
.. "' Lq :;'-4,+�6, 1 C 4-1--* --t 1 c t ‘ G U v// 0 See note on back regarding River Basin rules
66 C4 1 /p C,-'1 1 . 1- S2 ' i;( '- /I ,,, ( r' .i) /.,,,/r r t4,1
0 See additional notes/conditions on back
f ;(-- fT-_ :a 1A.;o,J . P Fr) L .Ao-k- 11;-i 4•? f)o' re
•
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
Signature"Please read compliance statement on back of permit** Signature
;41:7--_ illtIr — 2CI12- .27 - `,',\; G -'•7,Z
Application Fee(s) Check 4/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: Bettie, 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

,p'"'As's`-,,,I ''1CAMA I DREDGE & FILL N° 85139 ABCD
Previous permit
z GENERAL PERMIT Date previous permit issued
›C 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:
15A NCAC Rules attached. General Permit Rules available at the following link:www.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 n CW n EW n PTA 7 ES I PTS Adj.Wtr.Body (natiman/unk)
AEC(s): OEA IHA UW SPIMA I PWS Closest Maj.Wtr.Body ' ' r;- •
ORW:yes/no PNA:yes/no
Type of Project/Activity >-T< i?f ¢ `T - l- Al.e/ - .-i
4%., (Scale: )
Shoreline Length '
Access Length ;/t-t r,"Ybt• 1, S'P--:'
Pier(dock)length
--4*
Fixed Platform(s) ^ I ! I I
- V 1 ).. .
Floating Platform(s) { I 1 /'�,J
- I .
Finger pier(s) 1 4-- I
- 1
Total Platform area I
Groin length/# - ) . • _
-
Bulkhead/Riprap length --)-�.-+. _ .._._..._.. _ �,_.. .___. __
Avg distance offshore jz', <-k , r_• I, I + I • -
si
Breakwater/Sill - I 5 .
Max distance/length ' , ,' '
.264
Basin,channel i ` • I . • •4}:- C,-ti -c. • i
hwikl 1.-el
Cubic yards _ I - - e s z. a--.. 3 2-1,
�- 1 r,
Boat ramp Zf- '�.,,.E }, Th f I 7I��1 p
14, ��Y_ S
Boathouse/Boatlift I b)r w z�/"I ..• ) -fr s {`.tl
Beach Bulldozing M
-- - —
Other i 1, . ,
,t 4S E, 1. 1+ i . . T • ,
SAVobserved: yes no r- ..'reNf YMq I r4, '„�
Moratorium: n/a yes no { } ' t 1 t f { T '1^ 1�
Site Photos: yes no . ;''' 1 /4 - / L.---P�Jp �-I
Riparian Waiver Attached: yes no I /°f••••* I 1 i)
A building permit/zoning permit may be required by: 1I 241+,�T-f*' I I TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
7 I 1 See note on back regarding River Basin rules
• t,5,, S
II See additional notes/conditions on back
1-,I.,'
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
Signature"Please read compliance statement on back of permit" Signature
•
Application Fee(s) Check H/Money Order Issuing Date Expiration Date

Statement of Compliance ant 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit 1hbbi. Bette
Mailing Address: CR4 11QR,5 pert
Ro pnr tar. 021410
Phone Number '70'i-0Za5— rig
t3
Email Address: wi1eyieb 6?leaiy5beach -
I certify that I have authorized .i a MC►1;9anyacdan5ide.Contracto
Agent I Contractor
to act on my behalf,for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development ranow S'i.F anti .n5i'ut(
nc tx 0 c v;,ni( h,dkheci4
at my property located at 560 letv95 Batch r Rivet,
in V icIthtn Jon County. •
I furthermore certify that I am authorized to grant, and do In fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Properly Ownerinforrrtation:
,DAL 1rI
Signature
die 41;II�WI
Print or Type Name
True
� 2 t 22t 22
Data
This certification Is valid through��

N.C.DIVISION OP COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONiWAIVER FORM
CERTIFIED MAIL• RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. Debbie Y i I IG{Fe
Address of Properly: SIbO lea/.5s Bench pope✓ AG 2- 9-10
Melly Address of Owner: NOD Leith. c, teach I Roper,NC rig rlo
Owner's email:Wild/drb6'Irarp ca`Owner'aPhonelk rlC —.2, --9113
' AdsM'sNamo: JAmilligpn/CteaAstele-CdrfYtiC YrS�ntPhanefk 252- .'r—so
Agent's Email: Oceaw teJe.rrantYac irn', .cVhn;I.ceurn
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Wottom coition to be completed by the Adiaeent Pro0eety Owner)
thereby cerefytheti own property adjacent to the above referenced property.The indMdual appyingforthls
pewit 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 We letter.
'k I DO NOT have objections to this propoaaL I DO have objections to this proposal
if you have objections to what la being proposed, you must notify time N.C. Division of Coastal
Management(DM hi rifling within 10 dap of receipt of this notice. Correspondence should hi
mailed to 101 a Griffin St.,Ste.$00,Elhaboth City,NC,27000. DCM representatives can also he
contacted it(232J 2644901.No response Is considered thesams as no otdedfon R you have been
notified by Car/Med Meg.
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 deaden access unless waived by me
(this does not apply to bulkheads or dprep mvatmenta).(If you wish to waive the setback,you must alga
the eppmpriete blank below.)
sIDO Mato wakesomerailoftheis'astbeek 7,
Alleged R
-0R
I do not wish to waive the 15'setback requirement(Inifia!the blank)
manatum of Adjacent Rip:Oen Property Owner •//��n- ��1
7yTypadIPdnted non ofARPO: Jeri 1,4- f oytiN
etialegArdreeeofARPO; PIP /�A,c.7S /SCH Eon&A- NC- 2?j2-0
*ARPO's smalk 1 r qv Ili,'yo 6or .CerhARPO's Phone,~
*pate: J/L71io27_ swelverIsveildforupto one yeariromARPO'aSignatures
I Revised July 2021

N.C.DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAIION)WANER FORM
CERTIFIED MAIL•RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. 'fcbbie Li I�GThe.
Address ofProperty: SUE) Lealisexach Rope. Ak - Q1R1O
Mating Address of Owner. s(00 Leaf rite, huh , Roper,Nc. Z1 of 1O
Owner'semefl:wilcydrb@lear bach•ccoOwner'ePhoned; r7dF— ?r-`liI3
Agenfctlamo: JA1ni►lien/Ctetwk5(d AgentPhenet 2s S--a2 SFSGO
� c
Agent's Emelt ocPartwtde rrM vac-ie✓S FP 544n(I.rn v1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adiacent Property Owner)
I hereby cerlythatI own property edjecentto the above referenced property.The Individual appyingforthts
permit has described to me,as shown on the attached drawing,the development they are proposing.A
description ordrawlno.with dimensions,must ha provided with fife fetter.
* 17 I DO NOT have objections to this proposal. I DO have objections to this proposaL
O you have objections to what la being proposed,you must notify the N.C. Division of Gue tef
Management(DCM)In writing within 10 days of receipt of this notice. Correspondence should be
maned to 401 S. Griffin St,Ste.900,Elizabeth City,NC,MOD. DCM representatives pan also be
contacted et(252)2a4-3901.rib response Ls considered Me stuns as no objection IT you have been
notified by Certified Mall.
WAIVER SECTION
I understand that any proposed pier,dock,mooring pilings,boat ramp,breakwater,boathouse,Mt,or
groin must be set back a minimum distance of 16 from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprep revetments).pt you wish to waive the setback you rust eta
the appropriate blank below.) —�
s•I DO wish to waivesome/all ofthe 1S setbecki
nature offIgualit Ripedan Propon yOsyrer
-OFF
t do not wish to waive the 15'setback requirement(Mal the blank)
•
*Signature of Adjacent Rlpadan Property Owner.. •
iYTyped!Pdntsd name ofARPO: ;osw,t 1. �C1cti� T r�
nailing Adaraee etARPor 19 L-2 ./ 5 i 4 A f - - ,Ur >79 ?0
r (1
4(ARPO's em �L la I2 t J.c ARPO's Phone%
*Date: � *waiver la valid for upto one yearlromARPO'aSignatures
• Revised July202f