88903C - Kohr, Dwayne

coas88903
tNO F DREDGE & FILL A B C D
a &FICAMA
c�
a Previous permit
z GENERAL PERMIT Date previous permit issued
❑ New FI 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:
15A NCAC 1-1 Rules attached. 1-1 General Permit Rules available at the following link: www.deq.nc.g_ov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ZIP
Affected F]CW 1-1 EW FIPTA 1-1 ES FIPTS Adj. Wtr. Body (nat/man/unk)
AEC(s): 1-1 OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
i
(Scale:.�:�'
Shoreline Length
V 'h%/!JA%N.i%+/!ANl!/NAYlh%NN JNN/!l.W, ,%p•/JNN.IJ....:::.::.::..:: i::»l!!.,NN/Jlllx
#
JN //NNJ% N JNNN//Nry!J/N:n.....!:::..........::::::...... N//NI
r #£ s 5
s
/ yi
# ¢
,
t 4
h : 5 .,»...,..,»....,..._, ...,,...
Access Length
g
s £
# t ' 4 ss t
`s S 4
Q•t s
t t : #
f s 5 5 t # 1 is, s 4 3 S y # 5
3 _ ..,»M,. � ...... ...... ....... ...... ...... ..�...... .......s ..........;............ ..... .. £ f . ..s... ..y.... .....
t � t £ i # s
# t t
i # f
t #
l4 EE s i
s {{ 's
i
i 4
Pier (dock) length f:.r ,... ....... ::.». ...:.,;7 ;. .:,n,»:i » .,.,» .:,:..
t $
3 s 4
i tf s 5
,:,:,,»,.d:,,» »,» ..., .. .L,»: ,r...... ,r,»,»,r w:»»r.,», 3 »,»...,.. »„»r„i . »...:..........:.,.,✓ ».,r..»ro.s r,.»»,»,. » »». ,.,,.. ..,3»,�.,.:».,. ,,,,.�'t,,,,.,,»,,.5 ,3 » ,.,., »,,, »., .,.
, Y# , f 3
Cy s 4 t £ t # S s # s s £ 4
s
�.. s s
S � s 4
S t
4
£ i 4 r
# t' #
s � it i
: E s - s
# £! ss
4 »:»»»•n;.,.n,»:,..,,,»»„»,,,
•
Fixed Platform(s)
¢
., . ................................................
. : � o
s
.»» r,,.ro,.,,,:»i/»»:..,,»:Iy»,.,,»»,,,/.,�»„»„»...�'»»r,.»,n%,»,,,»»rw,.,:,,n,.»,' »»„ :»,:. »,»,,,,iy.» »:.... .,::,:...ij�,,,»»»3N»»,,,,»,i r,,,,,,,�,»,.,»,,,,�•,r,,,»r,,;,,,,»»»,,,i,»,»»,»7q»»,,,,»„%,,,,,.»».3y,,,,,»,.,,,5 »,ir, ror».G,»,,.,,ro»3, r„i ».»,.s�»,.,.,,.,.�
t t 3
D 4
t ,£ s.» »�», s f t i i» s
S £# # QQj
\ S
S
S t # 5 R
i . , 3
S # £ y
5 t 4
.. S
...................1...........t:.......... .,,..:. f ..n,..,....../..........,..:............: ..........J. ,...::.:.....:......:. s ,,,,, nn:,,,s,.,,,.: ..,.n 3»n ..»,: j».,.,,
,. :: y ny.
y 7 y... /
i � i .. # .. s _pppp g..,,, rti,,, n.�:n '�h`"ll4, S i
'£ g s s s
t t
.
Floating Platform(s) t
s: s s
t #
t
r �.� ty! '� 4 t t £ � r
.!,.,..,:.%l..A.J rArrrJ ...,,.,»», r„r,.»,d roar,. r„»r ,•%rr /, r,.,» „».,,,% »,.� ».,, ,,.w„»i ,»/J,r r,.,r„!.A»r, / ,,,,,»,J, ,,,,. ,,,.,,»,
..:;/,�,1 f 3lro. ...yro .ro3lrro , ,.M»» ».,4i» ` , 'N
t
� � £ � • ,Is � '. � `•+y '. # .:,,`� ''# ; � � 4 s i /''. sf'� s £L14
Fin er ier S
g p (),»»r».,.,,
,
,
# s
�,»,iirriN
/ ,
SSi WVO : 5£#
.,, s i , •.:s,r t ,,
,,,,» ,,,s , ,»»»# »», .,, „»rs»„»„»,a, »,,,. .,,,,. „»,,,,,,,,,,,,,,,,,,,»,.,,»,.,,,,,,,',,,,» ,.,,�,� », ..,sro: ,r,,.,s/,•.,rr /, .»ro,./y,,,,ro,�.wES�t ,..y», ».,S„r
•
$ # °i t # # # a� s # # £ £
9 , , h b, .. a
p
Total Platform area lN! ',occc:muN /,Jum A%!Ayl
t s # # # # a
„ ..�, ...... ...... ..4,.. ....... ..,..., .,.,.,.J,,....,...,,,..,,...,.,...,.1 ..,,.,... y y..y,.. .,%,., i t ,.S/,,, t
J"'."V
r
{ S #N.rn Y•r�:(fX# # .•eR'..'h £ i'�
{ t I 4$ 4 !!
�H N,%///J/N N/AN/i/N/J•/!N ININ%//r//!N//lNn/N NpNNN//%{ ��AWNI �.:r::.:::. : h�
/y,N £
"""s•+"�rF%.,i..^r�+.,•oK+�rirn3u£K.waypxvaniat
Groin length /# :ror �,,.
q»,.,. N3
# 4 s � # s
....... £ .,.,:»,pro» y » .r. ro,.,r ro ; ,rro ro,r.. »Mrro
t ssji t 4 # »,%gro,,, # > s
»:r,,,.
n t h � :... ,.,n,:. ...,..,.� .. . ........:.......:.
Bulkhead/ R i p ra length
p g 4 t 4
5;� # � 4,
#. ',:,..,, ..iro,,,:..rr: .n .. .... .... rv:,,, ,rorn n»., ...... .. .,, ,.,,,., ,.,,..,./n..,.r. „�,,, r.,.,, .,.r, rnn:,,.4
� :..,. £ ,..s£.. ,.y.. � s:,, rrof„ 4
...».,.in»..:..._d:....,�.., ,. ,.¢ � . n.., ,.,, .,. w - ro:�r„ a. � y �,,.,,,. ,rifrr sr.,
t t ;.�,
� 4 S 4
Avg distance offshore t t 9
t
S t
:
4. , ; s ter_., £,.. ... `,.. �,,. £ y.,. 4
#
,t {{
3 5
�»,»
s 4
Breakwater/Sill s
£ 3
3 # { #
g ,»» »»a,,,, y ,,, q,» ,:;y.`v,,, ... ,a,, *S =„ , A,.+,
5 £ »„Jy„» ,»�..»„»»,•K'�„ , £»» »,iy„» ,,,.y„»
_ # t # £
4 ..........S'i,.r»
Max distance/ length 4, �~
{: �
f 111
rrr »»» .�».� »»/ ./»»» / e,�„�»�»�' , ,ro.✓,enN/„� »» »»3 ro»��„% ,» »�n»»% nN» /��»� { y4 » f »<»»»�»i r»N» £ Nero».✓, »»»»�»,3/»�»,n,»' ro,
:,r ., y,. / 7 ,..,,, .%r.,/ J S n , !, N ,,,�,,,, ,,,ii,,, / �,., n/b. �„/,,.,r fi•,,,i ,.ro / / r r!„h rr, ! r�.,,,,,
„;-�"
s x:.t-4• '4 "�» # # £ s s $ � � s t 5. � # �'s' # i
i 'tip.
Basin channel 4
4
4
#. g 3 £ 3 # s 4
,,,,,,,»:.rs ,,,,,,»,»,J', »„$ ,,.,ror»roy,»»,»,,,,/N, „» ,,,,ro ,,,»„•✓iroro,,,,»»,.»,,,,»„/,»,.,,»»,//.,,,.,,,»,re,»„a,,,., ro„»,,,fr»» »,»».b ,,,,r,,,,,» / £ s s ,,,.4/», � r y s /yr, £ �rS�in" !
a tit s t # #
t t S
, 's i
EL # S t 4
Cubic yards ( s 4
f # i
# s t
t t 4 ! 4 £
i ( # t... #. t
4 5 t
t # 4 t t 's $
, f r t
I y( rr � t � 4
# y� V . ,"` '..1 # i. !' ",ram # Y S # s # # . #
£ R
y/�„ :,,,,.:
Boat ramps,..
/' ,:., „f f G � ,,, y, ,,,.,, . �,,,,,,,,,,,,, . .. #ro s
r.� Y ?,: ., £ „ ,).i• w J,,, ,,,.y,,, -, „�,.., ,,,4,,, ,:.I,,, � „�,,, � ,.5,,,.,,a�.. , q.
s k {
..,,,,.............» »,,,
„qs ,,,/y,»,„»�..3y»r
Boathouse/ Boatlift
JN/%///NA'NNNA',A'l/N/N!% /y NNNi%/%.yJIN/NJ/l/I/ENV/N/
N/N ///N/iJ/iNFNNMYN%,///N///N, I!/NN/JJNI //NN�//N%INN /NAyN//NH�/AYNNNIidp NN///J/NAW A'NN/f/ NH /l%//!//////l/%////JN /N%J/INNdr// /N�N//r/ // NN////N / /N//JN N //NI/% ////n A%/NN///,//%NN/N////N;yY//N/N//N%/�//NNNNN•�//INN//N/ /� ///r//� // % d///N/ n/�gN/AN%,l %� N /�.....
�
# � m
Beach Bulldozing �r �... . „ i
_
.!/4'NNJ,N/N
'i:,, ss £ t 5
♦N 3 5 £ s � t 3#
i = _ Ahr� t t
roN ,...,.,.%,,.r,,,,,,
nr� , !„ .,»r» ,»3»,r,,,., �.•,,,
Other 4 .
£ 4. S 4 �
s # �
# # 5
# t
# ,r •.1 _ t # r 1
t
� s. S 4 S „j s t :��L/ ,............ .,.§,. S t
�' ! ' i 3 is S S S
s � • s s � ss # s'j{ t., $ .,3 s.,,
)»i»,,..,»„%
.,..... � �..�.�.
..wq.,h.»», ,».: ....»».
..........
.....
S observed: yes no s
q,..»» ..,». ,3 , ,,,,,. / ».».in•.,.,,»» b .,,:wwr,,,,,,.,,,»i.,,,,%y,.,..,r»,»d»,»»».,.✓„»,»,,,,»r, ,»,,.M �..,,,..,,., i , ,.., »,..,.. ».,» ,d , � , .,,.,.»,j•,.,.»»,,.,3 %/.,»».,,»» ..£.•„»»,:,»J,�
# ,. f• „ » y..,,,.,,».ry»»» .. !...»» �..»....».�,.»,....».d+•n•„� £ s � t � t'J�.�...,,,..'
� S # s t s � � £ � s # , t �
's
y
'J"'N !"'i."' • ; //"' !
Moratorium: n/a yes no
k.
f N �/N N��/•ir p � , f !JN ! llrllJ / J,'/ / r /qj M' s ,iP," ` s /„"'" J.oii,l Nq' q' .Iw/�
., r rror, 96 rorrro.,,5.r ,»..»rod ,, ro
Site Photos. yes no s» ...»» f. , »
.. »»., .»»..,/.,.»...»r. »»., »,... ..r,. ,»».».i » �,.r»,.».:,i......,r,.»,% ».».».... .»., ,...G .....r r r r ....». ,r ro..,6...»..».,�...»»..............
_.. .,» »�.., y» 4{..S.. .,,.y»
Riparian Waiver Attached: es no��
P y
; t I�
A building permit/zoning permit may be required by:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
F]See note on back regarding River Basin rules
FSee 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 #/Money Order Issuing Date Expiration Date

®FCOM41 NO 88903
y ❑CAMA ❑DREDGE &FILL A g D
a 3 Previous permit
yrnGENERAL PERMIT Date previous permit issued
F-1 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:
15A NCAC FIRules attached. 1-1 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Affected 1-1 CW FIEW 1-1 PTA
AEC(s): 1-1 OEA ❑ IHA 1:1 UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Len h
5 -
/////////iij/is�..•.:,:r.:'�,:•,i:/.i/,i,/ii
.•,i.;:-i!:////i
/
.....-��....,........;.............................Access Length • ...... ...£
:
..
..... ..... ...... ........ . .
», ,: »
Pier dock length
"" "" _ -{ s
...................
...: ..... .. ...... ...... ...... ....:, , .....,,% .. ,.:, , ..., :.. :::. „b. . „ f�
Fixed Platforms -""
i.
...4. i
£
i
, £
!
£
:
. ......... . ............ — — ------------ �/� ............. ..........
t'
Floating Platform _- s �........... IJ ,
!
............ ..
s . .. ............ . . .......... / ........... . ............. ........... Z/
............. ............... ......... 1"'J/ ........... ;-,
Finger pier(s) z i �.
.........1.,,......,....... ». ....
..,,
s. ............. ............. r� ......... .............. ............. .........". . ............ ......... ............., ; ............ .............. ............ I I ........... . ............. .:
. .......... ............ ............
.. ............ ............
.......
........... ............. .............i 's
S
Total Platform are
a
r
/ / i n!r / , ,,� ,�• / // lrli;!!/,/ ,/ r , r / Jr r! r/ ///,•,li,/„! !/J,IJ ' !v JJ, r/ i ,./,!!///!/rir/!////„/:r////lJJI,//:r/,/J,r,r/r;rr/,lrr„J„/'//,/,,,,,/,/,�J,/„/!,/:. �/,//J,//r,,i rrJ,lr/�i//rJ�•r/nri//r/r/!/r/r%r//r//Jrrr/ri'r,/r,/ra
- ............ A,
�} r ,. ' '
Groin I e n h _ .."."." ............. ....." .,.".. ,. ..
wuwas��y9JsA� , n,. � i �p � s .,i„, �„
%
:
£
Bulkhead/ R i p ra p length _ s - �.-... ., �............,........,...,............;...:......-. •,............ ............:..... ..... ..... .
r�
r.'Y % '` '
S /
- S
• S
.: , ,
:. , . S , ' i
:. , . / S
•. S i S ,
Avgdistance offshore..........................,.............,............, ...... ..... ...... ................. ., ..s... i ,
£
:
S
S
5
3
., ...,./:.,.........i...........i....,......./:............5.....,......i............
Breakwater/Sill " ... ; ...; "., ".. .., £ ;
fr +. £
.1 vcvrr S� ,,, r ", ,; i i„ ,.;i"," fit.,, . r r ./,,,•,,,,i............:r,..,,,.,,,"..,.,..,,,,,.is,..,,,,,",,,sr,,,.",.,,.,,Sr,,,»,,.
Max distance/ length .:.M- i
Basin, channel
,.
�J
S i
S / - S
!
t '
r S
i
S
S
S •
Cubic yards ! /
Boat ramp
r
Boathouse B •f oatlift •y,
n% iC�irr,,,rr,/�""�"��'i�l�iliiiii%,iiiiiiiiiiiiii,iiiiri Beach Bulldozing
: : £ £
M
Other - _~
£
€`s, .•
/...........:........................................,............/ ..... ......
,
S Sji
j.•. .r/ _ _ / . / . /.. ,.. �.i r r.. .i•Y r.. , .Av ....,�.. ,.......%/...,,,ii...iiii.,..iri.......,.%,.,,i..,.,.i%iiii..,i.,.%,..,^u.,u.'ye...."'r"j"",...»»ii y0ii
SAV observed: es no 5"" """" ,
Y };
.,., .,,,,, .:•l;;.,;,.;:.. /,%,/,/./•. //////!!,//,/,/i„!,/i,/,/!,/lli',!,/!!!!llii'/!„!!/,/r!!%,!/!,/!/!,//ill!//„! /rr,r,!/!%/!/!!/,l,,,li ! ,r,//,/llr! ra i r!/r/!/!/!, ///,//,!/,/ !,r!/. rr!„lrrr%.,r./„!/!„lr/!„rr// !r,///lr/!r!/!/lrrrr% ,!/ll,,,/r ,/!„//r,/, r,,,,r/„ ,/,!/.%
,,,
Moratorium: ,,,,,,v,,,,,vvv,,,,,,,,,,,,
n/a yes no ,
Site Photos: yes no %"
+ s Aw
Riparian Waiver
Attached: es no
£
.........,,,,rr:,./.i:,.,,"./...y,.J,..,,,Jl,:.,,1.,.,,,,.,:r-r,.,,.,J,/,.i,.,.,..,,.,..,,..,.,.,i:..rl.,.r.JJ,ir<r,/,•,.r...:.,r.,r..,.,..i.,..,,.,,/r,...rr,.rnr,..J„liiiiriiiiiv%riiiiiii,iiiiiiiiiiiiiifii"iriii %riiiiii...i iii»iiiiii iiiii riirviiriiJi"iiub Jiiriiiiii%,irirr , rii ii.:i .. . ,ii%liiiiiiriiiiiriiiiiiiiiiiiiiiiiiiiiy�
A building permit/zoning permit may be required by: r
Permit Conditions
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
FIES FIPTS Adj. Wtr. Body
1:1 SPIMA 1:1 PWS Closest Maj. Wtr. Body
(nat/man/unk)
(Scale:
F—] TAR/PAM/NEUSE/BUFFER (circle one)
F]See note on back regarding River Basin rules
1-1 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 #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Narne of Property Owner Requesting Permit- — DWAYNE KOHR
Mailing Address- 125 BRIAR PATCH M DRIVE
CARLISLE, PA 17015
Phone Number: 717-648-8800
Email Address: [e-mail]
I certify that I have authorized DENNISS & SONS MARINE CONSTRUCTION, LLC
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMpermits
necessary for the following proposed development:
INSTALLATION OF FLOATING JET SKI LIFTS
at my property located at t, V3 Q- -11ZS15 00,
in CARTERET County.
furthermore ceffify that / am authorized to grant, and do in fact grant permission to
-,a/ Permit Officer and their agents to ef7ter
Division of Coastal Management staff, the Lo(Il
an the aforementione 4pnds in connection with evaluating., information related to Itthis
permit ication.
Prod dvOwn r Inforrriation:
1si nature ---
WAAJ
Pritit or Tyf.-)e Name
HOMEOWNER
Title
Date
CEIV 5--- D
This certification is valid through 12 31 2023 'ON N 1 2,, 2 0 2
Z-
'
til ­rY'N D U F Y

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER. NOTIFICATIOI` (WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT R_EQUU:;�TED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: y rJ © k+"
Address of Property: I R O } 51+L e. Y LA #J E ,, 1 � _� {�-
Mailing Address of Owner: `c 131Z14R,. PA 1--c. 14 J)RJ A I>c�r .
Owner's email: D,Ks t (?,,-0 Ai c '1',A)C-�wner's 'hone#: -711 C_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)
! hereby' Certify that I own property adjacent to the above referenced property. The individual apply inq for t�°;�s
permit has described to me, as shown on the attached drawing, the development they are propas4�q. A.
description or drawing.withdimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this propcsa
ff your 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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Cued 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.)
l DO wish to waive some/all of the 15 setback
Signature 4A* ntRiparian Property Owner
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 ARM
/V 2
ARPO's email: 17hd .�
hOOXOMARPO's Phone#: - "L,
Date:
�waiver is valid for Grp to one year from ARPO's Signature*
Revised May 2021

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: 1) W 01 y , i ir, o 4"2
1 0--
Address of Property: I R0 AS K L LA 4%J C � ���¢�4!�o►Z; 'JC,
Mailing Address of Owner: 13 K PA f�-
141Z% H ��Zi C4,� �-� � I PA 1-70 J
Owner's email: Phone#: ­ 7 0 — (a*8 " 8 8 0 C
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.
x
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 400 Commerce Ave., Morehead City, NC 28557. 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
Digitally signed by Jason M. Thomas
appropriate blank below.) DN: C=US, OU=Department 15, 0="Roberts
Jason M. CN=Jason M. Thomas,
E=[e-mail]
DO wish to waive some/al I of the 15' setback Reason: I am approving this document
Thomas Location: your signing location here
Date: 2022.06.03 08:18:00-04'00'
Foxit PDF Reader Version: 11.2.1
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:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
Jason M. Thomas
303 Joan Court, Beaufort, NC 28516
ARPO'S email: [e-mail]�y,o's Phone: [phone]
Date: OG.O3.ZO22 Waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

0 t
t>ac,].L 4:-042-
Cc s" 5
. � r
fix
pt.M�SlF
S x
Aot
i10
- '
s •
�
�Vl
�
r
J�
E
t PaoPc;LTy ap:
i
� Mk . �13�A1 'f1�+Wq-s