HomeMy WebLinkAbout87930_Edward Siler_20221104 ib 1lol14
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
'CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portionp to be completed by owner or their agent)
Name of Property Owner: ,c a y i ciR ,51,(/e(c '
Address of Property: 7�/ �f j��o^�p Y � - '
Mailing Address of Owner: .5/{N e
Owner's email: pp„/cR�n►yt ��,&jam Owner's Phone#: /r -91 412
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I awn 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 pf 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) 946-6481.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'se � /L3' E3 t'// 6
Si Adjacent Rip an Property ,ItV t!",�,([f�p
-OR-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner. ,e.. , tA,A A
Typed/Printed name of ARPO::��� vLb/l �� i \ - eiQ �n I, n, I_ p
Mailing Address of ARPO:'2S\gS Soc n c'L 1"�Oa . '�- P�P1� RL 1 28S •
;'ARPO's email:CC*"' 'V\Vtc3(he Otyj'�bct?ARPO's Phone#: c2) 445-0L84
Date:ID \2si 20 ZZ-. 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021
1
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue,Governor James H. Gregson, Director Dee Freeman,Secretary
Date /0/J67,‘,2
Name of Property Owner Applying for Permit: I
Ed ldud R.l� F. .4-Pa+Z►c a �1,1 . 6. 1er._
Mailing Address:
g n► Flo Re,oc1 12d .
Ime 1-1- , 1iC )45610
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) .n
at(my property located at) a 131 Flo kd 14uce
This certification is valid thru (date)
Property Owner Signature Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: 252-808-2808 1FAX: 252-247-3330\Internet: www_nccoastalmanagement.net
An Equal Opportunity\Affirmative Action Employer-50%Recyded 110%Post Consumer Paper
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT RE VESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. -I6uq el 2r c; o
Address of Property: 0Z./3I ce pL-
V ot06156
Mailing Address of Owner Sa
Owners email: Ie I MTh h'I'
fpwner's Phone*: ID y: C'i 2i 4
Agents Name:
Agent Phone*:
Agents Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comofated 13
the..v scene Properly Owner
I hereby certify that I own property adjacent to the above referencedproperty.
permit has described to me, as shown on the attached drawing, te development they arse applying
ropos for
A
descri tion or drawin with dimensions must be rovided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this pro
posal.
P posai.
tf you have objections to what is being proposed, you must notify Management(DCM)in writing within 10 days of receipt of this n . Correspondence sho the N.C. Division of Coastal
ld b i
mailed to 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted
a'(252)808-2808.No response is considered the same as no objection if you have been notified by
Certified Mail.
I understand that an WAIVER SECTION
y proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, rift,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 skin
the appropriate blank below.)
I DO wish to waive someJall 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:
TypedlPrinted name of ARPO: �,a / DM(',
Mailing Address of ARPO: /5qo i//45a1 fed loop re) /j1 4# ivc 2R4k
ARPO's email: twnt&4-Idc//c rGa.'I,4Rp0's Phone#:_ A4E-(,-Io-4 no
Date: lD-2 6-21-. `waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
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