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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: ti
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Address of Property: iLn
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urn tiA_ l �
Mailing Address of Owner:(Zf 11 �i� EVA'd) � Un L i 2aq(k i
Owner's email+ -,,��; j1, f'i /`gi Owner's Phone#: `teyl- 4F)
�s
Agent's Name:
Agent's Email:
Agent Phone#:
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.
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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 264-3901. 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 PropAy Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
v`
Typed/Printed name of ARPO: JQ of C7& i _
Mailing Address of ARPO:
ARPO's email:CO-d-'j I! C2 Vez 1 idn- n-/ 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 NOTIFICATIONMAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner,
Address of Property: (0t Lx�,Q r Z (.iL i jut' ; Lo.- `ttElcy , kllc
Mailing Address of Owner: I �Vt ntia,�( ; ll A `'� 34,e4
Owner's emaiICZ-}L7S � k Q V'L'C'i :`l Az1 Owner's Phone#:
I-) o
Agent's Name.
Agent's Email:
Agent Phone#:
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.
ti
_ 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 264-3901. 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 ,
f�
Signature of Adjacent Ripbriaq Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: �?
Typed/Printed name of ARPO:`- ' ,4?�{
Mailing Address of ARPO: y,['mr Sri? 9. }_c lil-� �i �{(O
ARPO's emailr,�6 ARPO's Phone#:
Date: s`�_7 "waiver is valid for up to one year from ARPO's Signature"
Revised July 2021
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Currituck County GIS Data Viewer
Currituck County GIS
Phone: (252) 232-2034
E-mail: gis@currituckcountync.gov
.: i'lliMlIs
s �
Addresses
Communities
Ayd"
Sarco
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Corona
Cannock
Globs Woods
Grandy
Harbinger
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Kr tts Island
Maple
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Shawboro
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County Boundary
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Streets
Wright Memorial Bridge
Major Streets
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--- Arterial_Mapr
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Parcel Land Hooks
Parcels
Currituck County
Aerial Photography (2021
NRed: eat 1
Green: Band_2
Blue: Bantl 3
his map should be used for general reference purposes only. Currituck County assumes no legal liability for the information
hown on this map.
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