86317A_Franklin, Raymond, Terri_20220328

Applicant Name 1'
Address
City ZIP,_._.._.
Phone If ( 1...`L..."....f3.Z...j.... __
Authorized Agent,,
Project Location (County): _ . L+�: w /rC. _ ..... __......
___
Street Address/State Road/Lot #f s} ....1 !.t� L _,_,4J�/` E!_) l _
Frrrail _. r GAL �C P_1 a Subdivision
cry ...._ C .c4- ZIP
Aff reed F cw [_YEW e..MPTA ES PTS Adj. WE, Body _ �' � e�%7r�tL` na
AEC(s): Elm ._4 fMA ] UW El SPIMA PWS Closest f-ta}. Wcr. Body,
ORW: yes — C�PNA: yes _.._
Type of Project/ Activity,_,
Shoreline Length � �� r _
at
Access Length
Piet (dock)length ^ _.t� x �-'fitOle F,T��i.
11r� �
Floating Platform(
Faxed Riatfprni(s)
fl fFloating s} l/
piry
Finger pier(s)
Total nlalform area 1 tom( g
Groin length/9(�ar—
BulLhead;(iprap ength jf. r —V ! ff
Avg distance offshore //
Breakwater/Sill r7
Max distance/ length
Basin, channe#, u w „•
Cubic
yards
a w _
Bout ramp
Boathouse/ Boatlift_ % C Q).-
Beach Bulldozing
w
Other "
SAV observed:���,��� Yes
Moratorium: 'l`ilti�' yes no
Site Photos: no � u
Riparian Waiver Attached: yeas no {
A building permit/zoning permit may be required by;
Permit Conditions`i"AWPAMINEUSE/BUFFER. (circle one)
Sear note on back regarding Rivet Basin rules
__....__......... . .. _ ,. ...... .... ... .. See additional notes/conditicmis on back
i AM AWARE Cif STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. jnta. rase lnittal^�g�!
Agent ApplicantPR I TEp Name P raft 01 icer's P INTF D N4Vie

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WA VER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND I IELIVERY
(Top portion to be completed by owner or their ager t)
Name of Property Owner: 1° u H v" o ^c< 15, na d Le v Er a vi k( LA
Address of Property: 10 g 1 Wa 4-e ( 1 (0 a C lc , ty C
Mailing Address of Owner: 7 Suh,- tie. bsOCAVL itF (Vc
a7�4 q
Owner's email: R na d a0 (o r i Owner's Phone#: 3 3 6- zy O 1 4Yo a i
0-<3vv-to,i1.cd—
Agent's Name: Agent Phone#:
Agent's Email=
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATI')N
(Bottom portion to be completed by the Adjacent Property Oi ►ner
I hereby certify that I own property adjacent to the above referenced property_ The im ividual 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 objection! to this proposal.
If you have objections to what is being proposed, you must notify the N.0 , Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Corre �pondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM repres 'tntatives can also be
contacted at [phone]. No response is considered the same as no objee Lion 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 °,nless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the se aback, you must sign
the appropriate blank below.) /
1 DO wish to waive some/all of the 15' setback -OR-
—
Signature ofA iacent Riparian Prop C wner
I do not wish to waive the 15' setback requirement (initial the blank) _
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: ��� *waiver is valid for up to one year from ARPO's >ignature*
Revised July 2021
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