HomeMy WebLinkAboutEX19-20 Conniff
August 7, 2020
Mr. James Conniff
5 Emerson Road
Severna Park, MD 21146
RE: EXEMPTED PROJECT SINGLE FAMILY RESIDENCES WITHIN THE ESTUARINE
SHORELINE AREA OF ENVIRONMENTAL CONCERN (15A NCAC 07K .0208).
PROJECT LOCATION/ADDRESS – 36 Sailview Drive, North Topsail Beach
Dear Mr. Conniff,
I have reviewed the information Weston Lyall has submitted to our office concerning the
necessary filing of an application for a CAMA Minor Development Permit under the Coastal Area
Management Act and have determined that the activity you propose of a single family residence and
shoreline access is exempt from needing a CAMA Minor Development Permit as long as it remains
consistent with your project drawing dated July 31, 2020, and it also meets the conditions specified below.
If your plans should change and your project will no longer meet these conditions, please contact me
before proceeding.
SINGLE FAMILY RESIDENCES WITHIN THE ESTAURINE SHORELINE AREA OF
ENVIRONMENTAL CONCERN EXEMPTED
1. All development shall be located at least 40 feet landward of the normal high water level from
waters classified as Outstanding Resource Waters (ORW). No ground disturbance or land
disturbing activity shall occur within 40 feet of the normal high water level of waters classified as
ORW.
2. This exemption authorizes the perpendicular shoreline access, not to exceed 6’ wide.
3. The development may not exceed a 25% built upon area within 575 feet of the normal high water
level of waters classified as ORW.
4. The development shall be consistent with all other applicable CAMA permit standards, North
Carolina Building Code standards, local ordinances and local land use plans in effect at the time
the exemption is granted.
EX19-20
5. This exemption does not allow for any fill or excavation within any wetlands or open water areas.
Any proposal to modify or alter the development plan as proposed will require additional
authorization from the Division of Coastal Management.
This exemption does not eliminate your requirements to obtain any other State, Federal or Local
authorization. Construction of the structure authorized by this exemption shall be completed by
December 31 of the third year of the issuance date of this exemption.
Sincerely,
Brad Connell
Brad Connell
Environmental Specialist II, DCM
cc: Roy Brownlow, DCM
Kate Winzler, NTB Permitting Specialist
LAND SURVEYING
214 Highway 17 N. Suite I
Holly Ridgc, NC 28445
910-329-9961 Office
Firm License # P-0937 www.WestonLyalLne.t
July 26, 2020
To: North Carolina Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Subject: 36 Sailview Drive, North Topsail Beach, NC 28460
The purpose of this letter is to notify the North Carolina Division of Coastal Management of
the proposed single-family residence to be built at 36 Sailview Dr. (PIN# 428705180435),
North Topsail Beach, Onslow County. The property owners are James Conniff & Sara White
Hall, who can be contacted at (410) 320-0476. Please see the enclosed CAMA Minor Permit
Application as well as the preliminary plot plan for the proposed dimensions and location of
the project.
Thank you,
Weston Lyall, PE, PLS, PLLC
Pile Plans, Foundation Designs, Structural Designs, Structural Analysis,
Stormwater Designs, Commercial and Residential Properties
Subdivision Designs, Land Surveys, Plot Plans, Elevation Certificates
All Your Engineering and Surveying Needs
Licensed Engineer in NC, SC, VA, AL, MS
Licensed Land Survevor in NC
dA 'Nil
Coastal Management
ENVIRONMENTAL QUALITY
APPLICATION FOR
�KMA�U�MA�U� I h6TH-1—It
U I .. 7►5iT1➢
In 1974, the North Carolina General Assembly passed the Coastal Area Management Act
(CAMA) anti scat the stage for guiding development in fragile and productive areas that
border the state's sounds and occ-anfront. Along with requiring special care by those who
build and develop, the Crencral Assembly directed the Coastal Resources Commission
(CRC) to implement clear regulations that minimize the burden on the applicant.
This application for a ininor development permit under CANIA is part of the
Commission's effort to meet the spirit and intent of the General Assembly. It has been
designed to be straightforward and require no more time or effort than necessary from
the applicant. Picase go over this folder with the 1,ocal Permit Officer (I.XO) for the
locality in which you plan to build to be certain that you understand what information he
or she needs before you apply.
Under CAMA regulations, the minor permit is to be issued within 25 days once a
complete application is in hand. Often less time is needed if the project is simple. The
process generally takes about 18 days. You can speed the approval process by making
certain that your application is complete and signed, that your drawing meets the
specifications given inside and that your application fee is attached.
Other permits are sometimes required for development in the coastal area. While these
are not CAMA-related, we urge you to check with the Local Permit Officer to determine
which of these you may need. A list is included on page two of this folder.
We appreciate your cooperation with the North Carolina Coastal Management Program
and your willingness to build in a way that protects the resources of our beautiful and
productive coast.
Coastal Resources Commission
Division of Coastal Management
RECEIVED
AUG 0 5 2020
IX " M Form 1`131952-2015/Revised DCM-MHD CITY
RECEIVED
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GENERAL INFORMATIO 010z 9 0 9AV
LAND OWNER - MAILING ADDRESS
Name k4m (33AI333U
Address
City _,�QWM State Zip Phone 410, 3W - (A-1(o
.. . .... ...........
AUTHORIZED AGENT
Narne—wistbo— Ulelt I K, RS..
Address
City State Zip_28�6 I'llione !3 to, a2q.qq� I
Envail
LOCATION OF PROJECT: (Address, street n-anie and/or directions to site.; name of the adjacent waterbody.)
2 43�
113114-2,3-7c)��( 00
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
SIZE OF LOT/MRCEL: 24,.w_2__square feet OV'7 acres
E]) Conlinercial/Industrial [:] OtherPROPOSEA) USE: Residential (Sinoe-family �i1�1i�Iti-family
COMPLETE E ITTJE R (1) 0 R (2) BE LOW (Conwayotir Local Permit Officer if.vou. are not sure which AEC (q)lVies
lujfilar l)roper(11):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED 'STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BU11,I)ING FOOTPRINTAND 0TVIER IMPERVIOUS OR BUIL"I'
UPON SURFACESW, square -feet (inClUdes the area of the foundation of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STXrE STORE' MANAGEMENT PERMIT-. Is the project located in an area suljeet to a State
Storinwater Management Permit iSSUed by the NC Division of Energy, Mineral and [,and Resources (DEMI...R)?
Y 13.1 S NO_��
If yes, list the total built upon area/imperviOLIS surface allowed for Your lot or parcel: square feet.
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DRIZATION FOR CAMA PERMIT APPLICATION
e5 ev.
Na me, of Property Owner Requesting Permit
.� Ja— -ev,.,
a 4n Address,
MA -
Phone Numbers
Email Address ri.1�.AW ne
w
�CWWY thatfhave authorized a t
to act on my`behalf, for thePurpose of applying fDr and obtaining all CNWA inn*its
necessary ki, the following proposed development:.
a
at
7! 33�•• g
MY.Property located at lone F
i gar s y1� ymof
?r'p e� rt x�+that I a' Rpg�g �g by g u o �`grant, ;end o ih� ict grant �' isj�'jI,
#'-30.�A�$ 3FS iA c gd L.F fR7 4: ,��[: ffi ri a� � Y.�i �� �'x.�A..�6x �G: rM I'L.�'La�r �d33�Li thejr agents �.rs e3f.��w �..
01Y `the afDrOtPlonfioned lees, in connection witt,� J �P ia�li���f r�F�I�`i�` f�J this,
permit.application,
,�..i _.,
�.,
i - � ..
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
& 1 4ft
ELEVATIM4 uERTIFICATE
Important: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date- November
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) buildinc.,, 0,v;,
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY
Al. Building Owner's Name Policy Number
CONNIFF JAMES M & SARA WHITE HALL
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
36 SAILVIEW DRIVE
City State ZIP Code
NORTH TOPSAIL BEACH North Carolina 28460
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc,)
PIN # 428705180435
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude- Lat. 34-30-15.88 Long. -77-24-12.35 Horizontal Datum: F] NAD 1927 nx NAI)
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance,
A7. Building Diagram Number 6_
A8, For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1341.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 11
c) Total net area of flood openings in A8.b 1408,00 sq in RECEIVE[)
d) Engineered flood openings? El Yes � No
A9. For a building with an attached garage: AUG 0 5 2020
a) Square footage of attached garage sq ft DC&4-&4HD CITY
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? 17 Yes 0 No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number B2. County Name B3. State mm
Town of North Topsail Beach 370466 Onslow North Carolffi�.
. .... . - ---- ---- -- . .........................
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8, Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood De,,,-W-.
Revised Date
3720428700 K 06-19-2020 06-19-2020 AE 12.0
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139-
Fj FIS Profile Fx] FIRM F] Community Determined [-] Other/Source"
Bl 1. Indicate elevation datum used for BFE in Item 139: D NGVD 1929 FxJ NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Exj Yes
Designation Date, 10-01-1983 Fx-] CBRS L] OPA
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Fl;*�c,�.�:
-r a I.j
ELEVATION ERTI `I TE . C IMB No, 1660-0008
Expiration Date: Nove ni
IMPORTANT: In these spaces, copy, the corresponding information from Section A. FOR INSURANCE (.',.
Building Street Address (including Apt., Unit, Suite, and/or Bldg, No.) or P.O. Route and Box No. policy Number
:36 SAILVIEW DRIVE
City State SIP Code Company NAIL Nujro
NORTH TOPSAIL BEACH North Carolina 28460
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. I"3uiltiirrg elevations are bayed on: fix:; Construction Drawings" J Building Under Construction Finished i';
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations- Zones AI-A30, AF, All. A (with BFE), V , Vl-V30, V (with BFE), AR, AI ,A, AR/AIr, AR/A1w-A 0, AR/Af ;
Complete Items C2.a--h below according to the building diagram specified in Item A7. In Puerto Mica only, enter metre
s.
Benchmark Utilized: Vertical Datum: Geoid 12B VRS RTK CPS
Indicate elevation datum used for the elevations in items a) throe' h h) below.
NGVD 1020 X NAVU 1988 Other/Source:
aturrr used for building elevations must be the sauce as that used fbr the BFE.
a) Top of bottom floor (including basemc,,;1r 1t, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V r,,)ries only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LACE)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
Check the areasur'c rDei;,
5.4 xl feet
..««_.
... , fn s : ..
14.1 feet
=
12,11 (; feet
,,....
N/A (x feet
(
i =x fer.=t rrr,at,
_,.........rc......
_ � «.......__ f��� fEe3et
et
J feet.;
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or, architect authorized by law to certify elevation into?
i certify that the
-�inft�r�rnation rtn this Certificate r'epreserts racy best effort; ire interpret the.dataavjil tfnder;5f8 f ' any `
e L 17 ent may �.7ei puni.� a g y fine orirn�risr�nment urrrter' �18 U� S. Grirje ertrr�tr �C3ii9. ......
Were latitude and longitude in Section Aprovided bya licensed land surveyor? . .Yes I.x No 'Check here if atta.,;.,'
Certifier's Marne ._ . . _..�
LicenseNumber
Weston Lyall i -4438
C3wnerlPLs
Company Name
tFES
l
Weston Lyall, PE, PLS, PLLC
Address _._�_......... ___
7
214 Highway 17 N. Suite 1 � � � eyh
_�_ .__ _ _ _ W_..__........._ .........._
City..__.......
... _ _«....,.h,._.........._
r State ZIP Code Y
I Holly Ridge
North Carolina 28445 1
Signature _ .................. «.«« WW _........
,ter' [date Telephone Ext.
_.
07_21'-2020 (910) 329-9961
Copy all pages f this Elevatrdn Certificate acid all attac hrnents far (1) community official. (2) insurance agent/company, and
C c�rrrrrtents (including type of equipment and location, per C2(e): if apf-lic.abtej � « ._..__...__.._.�--------------
This elevation Certificate is revised from the previous document dated 7µ7-207his elevation certificate is prRE I'EE)a 0
residence, Elevations noted are per construction drawings.
Section AID: The estimated enclosure area is determined from preliminary construction drawings. E�ood vent openings are
8"x16". Final calculations are determined with the finished constrr.rrtron elevation certificate. As per engine
enclosure walls shalt be constructed as break --away. Section C2 e: The proposed elevation of wood stand f C Unit.����
DCM-MHD CITY
FEMA Form 086-0-:33 (12119)
Replaces all previous editions.
tN;
ri
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November- 31".1.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANYLISIE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, Policy Number:
36 SAILVIEW DRIVE
City State ZIP Code Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, Brand C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only.
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or -
the highest adjacent grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement,
crawls ace, or enclosure) is ❑ E I feet El meters F] above or below the 1-1/v('31
b) Top of bottom floor (including basement,
crawlspace: or enclosure) is ❑ feet [1] meters ❑ above or ❑ below ti-in i
E2, For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of lnstructiow--;)
the next higher floor (elevation C2.b in
the diagrams) of the building is n feet n meters E] above or E] below tlie.
E3. Attached garage (top of slab) is
El feet El meters n above or [_1 below th
E4. Top of platform of machinery and/or equipment
servicing the building is 0 feet n meters F1 above or [_1 below tl ie 1F!?11::.,t
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? E] Yes E] No n Unknown. The local official must certify this information in Secti(A';
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (Without a FEMA-issued or
community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
. ......... . .... .... ....... .......... ..........
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
RECEIVED
AUG 0 5 2020
DCM-MHD CITY
F1 Check here if attachinelt
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page
ELEVATION CERTIFICATE
OMB No, 1660-0008
Expiration Date, November
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No,
Policy Number:
36 SAILVIE\A/ DRIVE
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measuremeni
used in Items G8—G1 0. In Puerto Rico only, enter meters.
G 1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyo,
engineer, or architect who is authorized by law to certify elevation information. (indicate the source and date of the elev,*:1h(,:rs,
data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BF-'_'
or Zone AO.
G3. ❑ The following information (items G4--G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Pert -nit Issued
G6. Date Certificate of
Compliance/Occupancy Issued!
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement)
of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑] feet ❑ meters Datum ..........
G10. Community's design flood elevation- ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C2(e), if applicable)
RECEIVED
AUG 0 5 2020
DCM.MHD CITY
❑ Check here if
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form P,
. . ......... ------- - --- . ......
IRE
BUILDING PHOTOGRAPHS OMB No, 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date- November 3")
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY Uc..'F:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, Policy Number:
36 SAILVIEW DRIVE
City State ZIP Code Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to!
instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side Vi&p.."
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openinICIS
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Photo One Caption
Photo Two Caption
FEMA Form 086-0-33 (12/19)
Photo One
Photo One
Photo "Two
Photo Two
Replaces all previous editions.
RECEIVED
AUG 0 5 2020
DCM-MHD CITY
Clear Phoi,,,
Clear
Form Pa., -Al:,
0
BUILDING PHOTOGRAPHS OMB No. 1660-0008
�i
ELEVATION CERTIFICATE Continuation Page Expiration Date'. November 30, ,./
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number-.
36 SAILVIEW DRIVE
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photogr< p'
with: date taken, "Front View" and "Rear View"; and, if required, "Right Side View"
and "Left Side View," When applic,,.
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
Photo Thkee
Photo Three
Photo Three Caption
. . ..... .... . .... . .....
Clear Ph-.-�',; "I
Photo Four
. .. . . . .............. .
RECEIVED
AUG 0 5 2020
DCM-MHD CITY
Photo Four
Photo Four Caption
. ........... .. . .
Clear PI
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Pac-11-I.;
ADJACENL.RIPARIAN
PRO
I eth-swm'ttherbyce6'I onpradiacon tooy (Name, of Property Owner)
ProPerN located at ir
ss Lot Block Rpad,etc.,)
in
KC
aterbody) xlv�`, wn andlor County.)
The eupplicant has descriw tru me, as shcrwn heic)w, the dew I ipment.proposed at tj"M er- p
locatiom
I have no objection to this proposall,
I have objecfions to fills proposaf'.
DESCRIPTION ANUOR DRAWING OF PPOPOSED DEVELOPMENT
0P
(lint Mwalproposhig tr-1`,wft1. r"US0 %fill ill d0s,"fiPtiOn 010W ar',gfiach a site drawing;
16LAIV
I understand that xBaer. d0fX'rr1006J1,CJ pifingl-6. boat ranip, breakwater, buathouse_ lift, oi-
be set ba(,*k a m0nimurn
d.istanec-, of 15, frog) my area of riparcce-SS-Unless waived -by.
ou wisil to wa
iv e ties etback, you must Initialthe appro asat blank below.)
I do wish to waive- the 15' setback requirement,
do n0t WiShtn. waive tfh(, 1 F setback mquirernent,
JPtoperty Owner 1pformation)
(Adjacent Property Owner Information)
. Dale I- ,
IS11 1,91 f1th,
At
-------- - -
2- Yj
cc roo t
J:) 99CEWED
:i ,;
,� �IF �~ i � P F� r�
AD QQfT.1RJPAR1ROPER MVffl _gR ATIL ME�NT,
I her8by cedify that I own proNtty wi.jacent to
2- (N= e of Property Ownor)
property located at
esS Lot I R
(Addr B oCk, I 0m, etc.)
on fq t
lip W _,WVY N,
In
(Waterbody� (CityfTown andlor County)
The applic-ant has descrfbe0 W me, as IJ-Muwfl bc-(W the dev-PJopmnt propoged at the above,
I have n1a obje0on to tiiis proposai
I have objections to this propoSlll.
DESCRIPTION ANDIOR DRiiii676F PROPOS50 DEVELOPMENT
WV004 d0VOPPMent Must fiff'in descripWon below or 08,40
V-A LV E Ft k-'E-'(:LTLQ
I understand that a lift; og pifings, D043f ramp, breakwater, boath mise.. or grom
must be Set back a minimion. distance waived -
of 15' frorn rny areaof riparie',;,f) access untess Auy—
me you Wish tO W -s'--e-kback-, y I ou rn ust initial the appiopria te blank Rio
I do wish to waive* tyre 5'setback requirermint.
I do nOt wish 10V60ive, the
(Propettrowner I formlation) (Adjacent Property Owner Information)
— a4n
Y,
4VJ
Telepoom Number / ernail addoms
P"nt < 7' Name
ypo
fWaffill gr- Ad d ross
N
wyf,Sfia
7'r*-WxVw- lfx-r.,,,� ama# adritess"
"Valid for one calondar ye& after Signature" RECEIVED
AUG 0 5 2020
Wevkwd Aaq 20U,