87826B - Joe Paul

, °``°"ur¢ I ICAMA I DREDGE & FILL R�� No 87826 ABCD ,
o+. GENERAL PERMIT 1D 14 -712 `A � Previous permit
c
Date previous permit issued
New Modification Complete Reissue I 1 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 L :4 • I Rules attached. n 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#( ' Z) `/r r--7
Email -• ' Subdivision
City ZIP 1 h:I Li
Affected CW _EW PTA ES PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): EOEA IHA UW SPIMA PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity 1\3 f L
(Scale:! ' _ 34,'"
Shoreline Length
I
Access Length ! i..._._ ,,! -IT._--- Pp,44i,t i(..-.__t? 'J .•
Pier(dock)length • !I'• 1" �" i c,r I k C11
Fixed Platform(s) �t,.�` ,. ' ` r; 'i�:`, �``� �'
Floating Platform(s) iI i 1
Finger pier(s) _
Total Platform area „lk-- (� �C ,� )+
Groin length/# -f 1 i
Bulkhead/Riprap length I--_.-- , ----
Avg distance offshore -- — -
Breakwater/Sill 1 I 1
Max distance/length_ I I 514 +') L' �� �+
Basin,channel t Y' w L t`�. q
rJ
Cubic yards .�,.... - L�'f --Z.
1
rjj y ,
T � j I D I t.e o'-
Boathouse/ H Kr"'I..• 14 l e..i--,
Boat ramp �y
Boatlift i ( / (t) }-
r
11LJh
Beach Bulldozing OW 4 AWL,i.
Other at -L �.11�)^ xiv ' _ I- `."•-,
I r �
I h
SAV observed: yes no - i ry�,o�c\A ' - ' I A �'r
Moratorium: n/a yes no - " / i 1
Site Photos: yes no
Riparian Waiver Attached: yes no �' - I t
A building permit/zoning permit may be required by: -
Permit Conditions TAR/PAM/NEUSE/BUFFER(circle one)
II See note on back regarding River Basin rules
lI 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
Signature**Please read compliance statement on back of permit** Signature .
_J 2', - j"i/ a .- l-(?- Th., D2.2
Application Fee(s) Check#/Money Order Issuing Date II Expiration Date

i
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

`'°�'A` I CAMA DREDGE & FILL � Q 87826 ABC D
y
GENERAL PERMIT ID Z`/ `i Previous permit
Date previous permit issued
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:
I5A 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 CW EW I I PTA ES I I PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): OEA I I IHA I I UW I I SPIMA I I PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity t • ;.aJ �-% (-
L`\ L (Scale:E -c.)'
Shoreline Length
Access Length - i -, is
-. '
•
i I
Pier(dock)length ,' ; I[
Fixed Platform(s) I .,, �, `
k T�
Floating Platform(s) • 1
j . . .
Finger pier(s) _ I I
•
1
1 }
Total Platform area I _-a - ,- x i • ,
•
Groin length/It I ! . _ . ,
Bulkhead/Riprap length -- -- - � ..e'''.
.. __.. t.._..._.._....---.___. 1 �._._._......._�_.
Avg distance offshore ----__......_..__.---- _---._._.....__--,__ ✓ �..._ ...__..
Breakwater/Sill — f I i
Max distance/length I �y 3 7- * {,
Basin,channel _i lg 4 e U
-__..__._- I -.-. 1 ..-.__.�--J yC'-- .. 4 x k Jt.- i'r - .._._.- .
Cubic yards r . I ,d `-
Boat ramp ___.___._._ ---- — ..Y- I }IA.)G.. c• . �'^ : �y ae
Boathouse/Boatlift j I 7 ;;,*.,.,. I i-,) %q,,: -
Beach Bulldozing !a; 'hi L
3
/Other1 c,, L• .
SAV observed: yes no • '
Moratorium: n/a yes no I;
. i I I I � 7, ��
. }� " ' �,' �' I
Site Photos: yes no '
Riparian Waiver Attached: yes no • : i
A building permit/zoning permit may be required by:
Permit Conditions TAR/PAM/NEUSE/BUFFER(circle one)
.+ See note on back regarding River Basin rules
,..) !
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
Signature**Please read compliance statement on back of permit** Signature
Application Fee(s) Check ft/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

n
A ROY COOPER
Governor
MICHAEL S. REGAN
., sever
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY p or
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Meuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC O2B.0233 & .0259. The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act(CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party(contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to$25,000 per day per violation.
i. Crossing is Perpendicular: Pier and docking facility access way must cross the SO ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees)unless otherwise approved by DCM. The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way.This
drawing will be used to aid in compliance-- and monitoring efforts. ja_tAr 4.
• Pre-project site conditions: (an/01- Zf MO/1, I`,J
By your signature below you agree to be held responsible for meeting all of the c di ions listed above d v ify
that all information provided is complete and accurate.
p
\` Nun
Agent or Applicant Printed me Permit 0 cer's S gnature
,,-)/(^- C..S1-Q3`—' Ik(. .______As.._
AS 44, --,a&-r--Z
Agkfit or Applicant Signature Issue Date
CAMA GENERAL PERMIT#: 9-1- O�(, .3
State of North Carolina I Environmental Quality I Coastal Management
Washington Office I 943 Washington Square Mall Washington.NC 27889 I252-946-6481
Wilmington Office 1127 Cardnal Drive Ext.Wilmington,NC 28405-3845 1910-796 7215
Morehead City Office i 400 Commerce Avenue Morehead City.NC 28557 1252-808-2808

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' • - ' N.C. DIVISION.OF COASTAL MANAGEMENT .
• ' • ' • , ADJACENT RIPARIAN PROPERTY OWNER NO11FICATIONIWAIVER FORM' LL
. = CERTIFIED MAIL•-RETURN RECEIPT REQUESTED'or.HAND.DELIVERY ,
(Top portion,to be:completed by owner or their.agent)`
Name of Property Owners 5 'C ., :''k Cl k -
I Address of Property - IR 5- Fist F q[e "V,eui La ule:`I �'jf«o ves'-Cr J i IC 278 197
- Mailing Address of Owner.. ..,r Wka-.-- - - _ "
Owner's email:: . 5 orecc;pclru l li,*.001184 g:c° rier's Phonett , -782,'y 5 6'16-2:-
• Agent's Name -, • ., -.'. Agent.Phone "-- . -
AgeM's Email' '
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION " • ,
;- (Bottom portion to be completed by the Adjacent Properdv Owner) " -
It,.. : I heneby oertifyrfl at I own propertyiadjacentto the above referencediproperty.The individual applying forthis
permit has described to me, as shown on the-attached'drawing,the development they am-proposing.A
description of drawing,with dimensions.meettbe provided with this letter; .--- -
)( I DO NOT have objections to this proposal I Do have objections to,this proposal ""
If you have objt ons to what is being proposer you,most notify_the N.C.Dhdsion of.Coastal '
Mmogement NCMI in writing within 10 days of receipt of thLcnotice. Correspondence should be "
mailed to 94$Washington'Square Mart, Washington,,NC 27889 DCM represe ves-can also be
-`contaclod at(262)946.61df.No response is:considered the same as no objection Nyo t have been
notified byfartiiedAbil. • , - ,
r; _ . WAVER SECTION - - . .
I understand that any proposed:pier,dock,mooring prTirgs, boat ramp,breakwater,boathouse,riff;or
grain must be set back a minimum distance 01.15'frommy:area of riparian access unless wai ectby me
(this does not Apply to bulkheads or riprap revetments) (1f you,wish to waive the setback,you piust sign, '.,
the appropriate blank below) _ -.p
I DO wish to waive some/all ofthe.l5'setback • '
•
14ft
-OR Signature ofAdjacentW party owner
do not wsh to waive the 15'setback"negwrerr nt(nitial:he blank)' Al '(
)C Signature ofAd aceProperty
Adjacent Riparian ._ •� ,<
- owner. '
r, TYPaii!Pnnted•name of ARPO L ' r , ' s` ' . = t• ,•:S' .
Malting Address of ARPOe} ,?l}813 fe4ske c.J- R •�i id Q.: L 2ScLgr .. •
•
ARPO's email , .4•&CI4 ¢gyp s'-ARPO's Phone#: t52-53I "f %t'7 •
Date: fi-- Z `c•r�
? ;''waiver, is valid for up to one year from-ARPO'sSignature•
Revrsed:Any 2021; -

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TIPS FOR ADJACENT RIPARIAN' NOTIFICATION&WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A d,
NCAC TJ:0204(b)(5)). Proof of actual notice(a sign-off by the owner on,this:form) or certified mall return ,
receipts(showing delivery of notice)am needed. .
The purpose of this notice Es to make adjacent riparian property owners aware of the proposed development ,
so that they have an opportunity to provide comments(or potentially object to)the proposed development,
and to,give DCM an opportunity to consider these comments/objections before a permit decision is made.
'Permission'of adjacent property owners is not necessarily requiredfor DCM to issue a permit;however, '
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area °
along the riparian access area of the adjacent property,as determined solely by DCM.It is In the applicant's
best interest'to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process.In addition,if the adjacent riparian property owner appeals the
permit decision,insutficientnotice could be a basis for granting such:an appeal .
Who is an Adjacent Riparian Property Owner't
What is Adjacent?(Note:DCM reads this broadly to ensure comment,by potentially impacted neighbors)
• A property that shams a boundary line with the site of proposed development;AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation,even a kayak or canoe,including a common canal system
or a manmade basin. . ,
• Easement holders?Yes,if the easement could'be impacted by the:proposed development.
• StreetslRoads?Only if the street/road could be impacted by the proposed development This ` ,
° might include street-ends which might beaused for parking and beach access.
• ,-Holders of recognized submerged lands claims/shellfish franchises:
is •
;
What,is Riparian? ° . , . ° - ,
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If them is a '9
question about whether an adjacent property is considered"riparian," please math out to'DCM Staff-
especially on the oceanfront beach where them may be undeveloped parcels on the beach or in the water.
wholWhat is a Properly Owner? I
For private individuals<or families),send notice to the address listed on the tax card.If the property is owned
by an Inc.or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
I State's Corporations Look' Up site: httosliwww°sosno,gov/search/index/core. For 'Condominiums or
neighborhoods with an owners'association(HOA/POA),send notice to the association (which is usually a °
corporation,for which you send notice to its registered agent). °
What is Notice,and how do I ensure it.is received?
•t. You can meet with your adjacent property owner,provide a description or drawing of the '
proposed development,and ask them to sign thisform and return it to DCM;OR "
• You can hand-deliverr this form and a description or drawing,and ask your-neighbor to return It to
°DCM(consider providing them with a stamped envelope);OR .
•.- You can mail this form by USPS Certified Mail,return receipt requested(the Green Card). If you ,
_ ,choose this option;you must provide either the signed&returned green card'OR'track the
certified mail package number on USPS.GOV's online tracking system,.and provide the tracking .,
print-out as proof of delivery to DCM
If you have any questions about this process, please mach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions: .
- Revised July 202t

CERTIFIED MAIL° RECEIPT
Domestic Marl Only
1 For delivery information,visit our website at www.usps.com....
Dxcin :Htn J1 VT4
1g4,0
3 Certified Mail Fee $4.0U 0056
ic 05
o Extra Services&Fees(check box,add fee aaerfsrte)
❑Return Receipt( copy) $ ���M 1�, JUJ
a 0 Return Receipt(electronic) S $0-00 Postmark
3 ❑Certified Mall Restricted Delivery $ $0 00 Here
:laden Signature Required S
7 ❑ I}.00
lfl
Adult Signature Restricted Delivery S
3 Postage $1 .44
s
07/25/2022
Total Postage and Fees
$8.69
sangJ ea iN O. ►'NA44h:s
7 Street-- or PO No.
titYte sta 4 y c L L rktr9 lock- 2.54745

A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. LISPS®-postmarked Certified Mail receipt to the
A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
'portant Reminders: -Adult signature service.which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
Frst-Class Mair,First-Class Package Service®, available at retail).
or Priority Maila service. -Adult signature restricted delivery service,whicl
Certified Mail service is not available for requires the signee to be at least 21 years of ag
International mail. and provides delivery to the addressee specifier
Insurance coverage is not available for purchase by name,or to the addressee's authorized agen
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
Insurance coverage automatically Included with accepted as legal proof of mailing,it should bear r
certain Monty Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office—for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.

•
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. pre.;
IIPrint your name and address on the reverse ❑Agent
so that we can return the card to you. dresser
• Attach this card to the back of the mailpiece, B Recei (Printed Name) C. Date f Delivery
or on the front if space permits. "�� d7`27 22
)Art
icle Addressed to: . I el ery address dill ite 1? ❑Yes
�e�N Ot �` YES,enter delivery add low: 41210
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' R3. Service TSignaturMaile J { ' ❑Registered MSIITM
❑Adult Signature Restricted Dellfety ❑Registered Mall Restricts
GEcCertified Mail® � �e livery
9590 9402 4896 9032 8311 06 0 Certified Mall Restricted Delivery �'Retum Receipt for
❑Collect on Delivery ��,�`"`MMMMerchandise
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❑Insured Mail 0 Signature Confirmation
7021 2720 0001 6285 6517 ❑Insured Mail Restricted Delivery Restricted Delivery
'ver$500)
P' s Form 3811.July 2015 PSN io:su-uc- Domestic Return Receipt

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Jean D. Mathis
700 Broderick Drive
Oxen Hill, Maryland 20745
Jetty Permit:
I am applying for a permit to construct a 25 ft. jetty off my
bulkhead in an effort to build up sand. The Dept. Of
Natural Resources has indicated your signature is
required on the form I have forwarded to you. Please sign
where indicated and return by email or postal mail. Thank
you in advance.
Joe Paul
[e-mail]
85 E. Eagle View Lane
Blounts Creek, NC. 27814

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL- RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. n J 6 'e Pg.(A I
Address of.Property: 8 5 Fas fcaite V teul LcSe I brmah Crc@k I UC 27819-
Mailing Address of Owner. 5 'Pt I4&
Owners email: , o eQ pCett( � 11fl�'c°Otrners Phone* z5Z-I4= 56z
Agents Name: -. Agent Phonet#: ---
Agent's Email:
•
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to he completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property.The individual applying forthis
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 pmposeo; you must notify the MC 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)9E16-6481.No response is considered the same as no objection if you have been
notified by Certified Marl.
WAIVER SECTION
I understand that any proposed pier,dock,mooring prrngs, 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 d t Pt
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Signature of Adjacent Riparian Properly Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank) N R
x 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 Signature*
Revised July 2021

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TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION&WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts(showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments(or potentially object to)the proposed development,
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and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adiacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area
along the riparian access area of the adjacent property,as determined solely by DCM.It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision,insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent?(Note:DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation,even a kayak or canoe,including a common canal system
or a manmade basin.
• .Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads?Only if the street/road could be impacted by the proposed development This
might include street-ends which might be used for parking and beach arrpss.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian,"please math out to DCM Staff-
especially on the oceanfront beach where there maybe undeveloped parcels on the beach or in the water.
Who!What is a Property Owner?
For private individuals,(or families),send notice to the address listed on the tax card.If the property is owned
by an Inc.or LLC, please send notice to the person listed as the registered'agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.gov/search/index/com. For Condominiums or
neighborhoods with an owners'association(HOA/POA),send notice to the association(which is usually a
corporation,for which you send notice to its registered agent).
What is Notice,and how do I ensure it is received?
• You can meet with your adjacent property owner,provide a description or drawing of the
proposed development,and ask them to sign this form and retum.n to DCM;OR
• You can hand-deliver thisform and a description or drawing,and ask your neighbor to return it to
DCM(consider providing them with a stamped envelope);OR
• You can mail this fora by USPS Certified Mail,return receipt requested(the Green Card).If you
choose this option;you must provide either the signed&returned green card OR track the
certified mail package number on USPS.GOV's online tracking system,and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process,please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
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Revised July 2021