HomeMy WebLinkAboutTaylor, Ginger 91135C❑CAMA ❑ DREDGE & FILL N9 91135 A B C D
N
y = GENERAL PERMIT 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:
I SA 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 ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be rc .. ,.
Permit Conditions
(Scale:: )
❑ 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"
Application Fee(s)
Signature
Check #/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:
1-1 Tar - Pamlico River Basin Buffer Rules 1-1 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
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: 252-247-3330
(Serves: Carteret, Craven —south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021
1*�F`°"�r'N&❑CAMA [I DREDGE & FILL N9 91135 A B C D
—ffii
GENERAL PERMIT Previous permit
2 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:, )
Shoreline Length
Access Length _
Pier (dock) length
Fixed Platform(s).
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no •---------<-----
Riparian Waiver Attached: yes no „, __.
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 #/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:
1-1 Tar - Pamlico River Basin Buffer Rules 1-1 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
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: 252-247-3330
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 6/01/2021
Styron, Heather M.
From: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Sent: Wednesday, February 8, 2023 4:26 PM
To: Styron, Heather M.
Subject: Re: [External] RE: Hill Street CAMA Waiver
Attachments: CAMA General - Hill St.pdf, Adjacent Riparian Owner - 224 Hill Street
(With Town Notes).pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Hi Heather -
I hope you have been doing well. Please see the attached documents for the application.
Thank you!
Hannah Cochran
Cleve Contracting, Inc.
Crystal Coast Marine Contracting
680 Swansboro Loop Road
Swansboro, NC 28584
(910) 325-8481
From: Styron, Heather M. <heather.m.styron@ncdenr.gov>
Sent: Wednesday, February 8, 2023 11:49 AM
To: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Subject: RE: [External] RE: Hill Street CAMA Waiver
Hey Hannah,
Once you have all of the paperwork for this please send me everything.
Thanks!
Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
Heather.M.Styron@ncdenr.gov
www.deg.nc.gov
Find a Field Rep (argis.com)
-A
0 artmont at Environmental 4uality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: David Rief <Drief@cedarpointnc.org>
Sent: Wednesday, February 8, 2023 11:29 AM
To: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Cc: Styron, Heather M. <heather.m.styron@ncdenr.gov>
Subject: [External] RE: Hill Street CAMA Waiver
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Hannah,
Please find attached the signed Adjacent Riparian Owner form with my signature on it for the 224 Hill
Street project.
Please let me know if you have any questions.
Thanks,
vma x a4
Town Manager
Town of Cedar Point
427 Sherwood Ave, Cedar Point, NC 28584
Phone: 252-393-7898
Email: drief(a�cedarpointnc.org
Website: www.cedarpointne.org
2
Disclaimer: The content of this message and all attachments are subject to NC Public Record Law.
According to the law all information except the property of a private individual is considered public record
and subject to disclosure upon request to third parties without prior notification. If you are not the intended
recipient of this message contact the sender immediately and delete the message from your files. Thank
you for your cooperation.
From: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Sent: Wednesday, February 8, 2023 9:25 AM
To: David Rief <Drief@cedarpointnc.org>
Subject: Re: Hill Street CAMA Waiver
Hi David -
I have attached the corrected paperwork.
Thank you for working with us on this project!
Hannah Cochran
Cleve Contracting, Inc.
Crystal Coast Marine Contracting
680 Swansboro Loop Road
Swansboro, NC 28584
(910) 325-8481
From: David Rief <Drief@cedarpointnc.org>
Sent: Wednesday, February 1, 2023 10:31 AM
To: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Subject: RE: Hill Street CAMA Waiver
Hannah,
If you can swap the old aerial photo out for your new aerial photo showing the proper orientation of the
dock in the packet you/Justin initally sent, I will be happy to sign it for you.
Thanks for working with us to make sure the Town's riparian rights were protected.
Respectfully,
Town Manager
Town of Cedar Point
427 Sherwood Ave, Cedar Point, NC 28584
Phone: 252-393-7898
Email: drief(a�cedarpointnc.org
Website: www.cedarpointnc.org
Disclaimer: The content of this message and all attachments are subject to NC Public Record Law.
According to the law all information except the property of a private individual is considered public record
and subject to disclosure upon request to third parties without prior notification. If you are not the intended
recipient of this message contact the sender immediately and delete the message from your files. Thank
you for your cooperation.
From: Hannah Cochran <hannah@crystalcoastmarinecontracting.com>
Sent: Tuesday, January 31, 2023 4:11 PM
To: David Rief <Drief@cedarpointnc.org>
Cc: Weychert, Curtis R <curt.weychert@ncdenr.gov>
Subject: Fw: Hill Street CAMA Waiver
Hi David -
So sorry for.the misleading picture. I have attached a basic layout of what we are looking to
install for the property owner while working within the set back. Please let me know if this will
work or if you need anything else.
Thank you!
Hannah Cochran
Cleve Contracting, Inc.
Crystal Coast Marine Contracting
680 Swansboro Loop Road
Swansboro, NC 28584
(910)325-8481
From: Justin Cleve <jcleve@crystalcoastmarinecontractin�.com>
Sent: Tuesday, January 31, 2023 10:33 AM
To: Hannah Cochran <hannah@crystalcoastmarinecontractine.com>
Subject: Fw: Hill Street CAMA Waiver
Justin Cleve, President
Cleve Contracting, Inc.
Crystal Coast Marine Contracting
680 Swansboro Loop Road
Swansboro, NC 28584
(910) 325-8481 (Office)
www.crystalcoastmarinecontracting com
From: David Rief <DriefCc@cedarpointnc.ore>
Sent: Monday, January 30, 2023 2:01 PM
To: Justin Cleve <jcleve@crystalcoastmarinecontracting.com>; jcleve@taskcontractine.com
4
<icleve@taskcontracting.com>
Cc: Weychert, Curtis R <curt.wevchert@ncdenr.gov>
Subject: Hill Street CAMA Waiver
Justin,
I received the waiver form, but wanted one clarification before signing it. According to your drawing, the
proposed pier would extend from the land at about the same direction as an extension of the property
lines. However, the aerial view of the waterway and orientation of the docks on Waterway Drive looks
like the riparian extensions should turn toward the west in order to be perpendicular to the channel.
Can you draw the pier, with its orientation on the aerial so I can see how it would align with the existing
piers in the area.
We are not opposed to the pier generally, in fact, we fully support residents increasing their use and
access to the waterfront, but in the event that the Town decides to construct a waterborne structure at
the end of Hill St for local residents some time in the future, I want to make sure enough space is
actually preserved for such use.
Thanks,
David M. Rief
Town Manager
Name of property Owner Requesting permit: t inpter 14110,
la e-mng Addreew 3805 Random Road
Kinston, NO 28604
MOM Number; too— _ I 7�.3
&W Address:
I 091W that I have authorized Crystal Coast Marine Contracung
�wiq i i�:r.ir
Arant / Contractor
to cot on my behalf, for the purpose of applying for and obtaining all LAMA permits
I necessary for the following proposed development: Construction of a concrete dock
at my property located at 224 Mill Street
In Cart"t County.
I furdm mtom certify that l am authorized to grant, and do in fact grant permission to.
.Division of Coastal Management staff, the Local Permit Officer and their agents to enter
,on ft afaramentioned lands in connection with evaluating information related try ft
permit W icatIM
property Owner Information:
eture
r N Tayor
Pitntor Type Name
owner
INS
Dote
This certification is valid through
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: Ginger Jones Taylor
Address of Property: 224 HIII Street
Mailing Address of Owner: 3805 Random Road, Kinston, NC 28504
Owner's email:
Owner's Phone#:
Agent's Name: Crystal Coast Marine Contracting Agent Phone#: (910)325-8481
Agent's Email: accounting@crystalcoastmarinecontracting.com
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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at (252) 808-2808. 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
BUZ
Signature of Adjacent Riparian Property Owner
70/? %h�"
I do not wish to waive the 15' setback requirement (initial the blank) Jon T Hudgins (Jan 30, 2321:49 EST)
,7oHT�oiuT
, 70/1 Th`�r"
Signature of Adjacent Riparian Property Owner: Jon T Hudgins (Jan Jrr,202321:49 EST)
Typed/Printed name of ARPO: Robert Or Jon Hudgins
Mailing Address of ARPO: 1550 Patuxent Manor Road, Davidsonville, MD 21035
ARPO's email:
ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
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,
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 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 access.
• 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 reach out to DCM Staff -
especially on the oceanfront beach where there may be 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: httl2s://www.sosnc.gov/search/index/corp. 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 return it to DCM; OR
• You can hand -deliver 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 reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 2021
2021-Adjacent-Riparian-Owner-Notice-Waiver-F
orm-with-Tips-M H C-July-2021
Final Audit Report 2023-01-31
Created: 2023-01-26
By: Justin Cleve Qcleve@taskcontracting.com)
Status: Signed
Transaction ID: CBJCHBCAABAAsm8XAe2T2olcJ048-r6kndePTenEjsfp
"2021-Adjacent-Riparian-Owner-Notice-Waiver-Form-with-Tips-
MHC-July-2021" History
Document created by Justin Cleve ocieve@taskcontracting.com)
2023-01-26 - 9:23:24 PM GMT- IP address: 174.106.205.126
C Document emailed to baysidehealthbiz@gmail.com for signature
2023-01-26 - 9:24:21 PM GMT
Email viewed by baysidehealthbiz@gmail.com
2023-01-27 - 2:53:51 AM GMT- IP address: 104.28.57.249
06 Signer baysidehealthbiz@gmail.com entered name at signing as Jon T Hudgins
2023-01-31 - 2:49:55 AM GMT- IP address: 75.178.86.13
136 Document e-signed by Jon T Hudgins (baysidehealthbiz@gmail.com)
Signature Date: 2023-01-31 - 2:49:57 AM GMT - Time Source: server- IP address: 75.178.86.13
Agreement completed.
2023-01-31 - 2:49:57 AM GMT
a Adobe Acrobat Sign
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: Ginger Taylor
Address of Property:
224 Hill Street
Mailing Address of Owner: 3805 Random Road, Kinston, NC 28504
Owner's email:
Owner's Phone#.
Agent's Name: Crystal Coast Marine Contracting
Agent Phone#: (910)325-8481
Agent's Email: accounting@crystalcoastmarinecontracting.com
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 (252) 808-2808. 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
ESTSZ
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: 5_�ly 6`1
Typed/Printed name of ARPO:
Mailing Address of ARPO:
o` 1ya
David M. Rief, Town Manager for Town of Cedar Point
427 Sherwood Avenue, Cedar Point, NC 28584
ARPO's email: drief@cedarpointnc.org
ARPO's Phone#: 252-393-7898
Date: 2/8/2023 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
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