86656A_Farless, Elliott_20220802

0 �ow—UN ,®CAMA ❑ DREDGE & FILL
@KNENAL PORMIT
N0.86656 ®e C o
nwo0ow
Woe prtf!"iouc permit hyAw
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As arrrha and by the state of North C v*a4 Uepartr.m ofErM onmerrW Quality and the Coa -W aesodrem Comn-&m on in an arm a nTwvrrrxr,d concern purtaant to:
I SA NCAC 7 i • ) A c [] Rules axuched. ® General Permit Rules avaiialAe at the fo — ft kk wv4w
Applicant Name E1
Address 2 1,4_—_1
Authorized Agent
Prcfect L-atiort (tern--��
City _ CyAelmsate ` , '� Z1P ;L-11 24 streetAddressrl., P-ad/Lot *W
Phor.e#(252 ?
&nW o* - jQk jeU Q 11 • Can Subdivision
city— Cole_ratn zip_xt4a�
Aflert d ❑ M ® EM, M ❑ n ❑ FTS AA. Wtr Body CKw:-Cl to 9yP r- �
AEC(.): ❑ OCA ❑ IHA ❑ UW ❑ SPNMA ❑ PWS Ma). Wtr. Body `ka�iY S
ORW: yes/G PNII• Yam}
Type of Pro- ACdvity a J'x Yo' K � 3' x sbr f ad yv f
Atness Length d • �Y�`
Pier(dock)length rJ ' X'SZj
Fwed Pladorrn(s)
Floating Pfatfarm(s)
Total PbdD m area
Groin length/S --
Bulkhead/ Riprap length ti
Avg dlslante of bore
Max distance/ length
fpathous�l Boatlift 13` X20,
Bpd,�Idoairg
Other M #Ski t
SAV observed:Yes 03 Li. i _. it
Moratorium: V{aJ YeS no r
Site Photos: no i—i
Riparian Waiver Attached:
aired
A budding perTnt/zonrng Perm- may be ►eq by
Permit Condt ions ❑ TARRAMMEIAEJBl1FffR lade arrej
❑ See note on bark neardiing River Basic rules
❑ See addlilonal rroaWwnddkxu on bark
I AM AWARE Of 5L%TUTE'S CRC RULES AND CDNDtTN)NS THAT APPLY TO TM PROTECT AND REVIEWED COMPLIANCE SrATE71 IM. (Please brltlal) E 8
Permit
SW azure "Please read compliance statement on back of permft" ' Signature -
it &)0. � I(459 a/z/zz
n Feel
Application Check g/Money Order Issuing Date Expiration Date

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: E I r0� I} 1 4^ A f -'q,4.5� A J
Address of Property: Z i g l 5 d� Iraq 1/o��a( �� xF,� u' M , A/ L 27 Q 2i
Mailing Address of Owner: S' --ke S CiLe�"
ll #. 9,4P, s C 1. ��
Owner's email: � �d C I Owner's Phone#: 2S Z ' 31' q '' (90(0
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/ 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 [phone]. 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' setbac
Signature of Adj ent Riparian Property Q6,ner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:}/ l� hL=64Ge i
Typed/Printed name of ARPO:
Mailing Address ofARPO: A 3,7 g' 412A-R i�=LG'y /� I7 a74a
ARPO's email: /1f6) 4/Z: ARPO's Phone#: ,? S- o. _ =A L?- 416 v
Date: 9--44 - -1� 7�1 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

5l
Aorr �IlNe

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)
I
Name of Property Owner: I 0T, / �✓ ��s5 ,�
Address of Property: Zl�l I �'S5 � .Jlnq &M� ���1�''^ , �' 27C(21
Mailing Address of Owner: 5gete Q5 Q&VIe.
Owner's email: e u \c . -k (ef S 0 m4,' 1. (--Owner's Phone#: 25 Z- T3 i - 1 g0C
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 [phone]. 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 Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: % c-
Typed/Printed name of ARPO: Ea e-d c►- R to, 5 0N
Mailing Address of ARPO:
[/ i // r= 1VC.270-7 b
ARPO's email•Phone#: S2 33 3 %yy
Date: r% - // - *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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