Gurley, Brad 90037C

40`°"4I I•CAMA� DREDGE & FILL N9 90037 ABCD
GENERAL PERMIT Previous permit
Date previous permit issued
d 1.c
New Mo Ificatition n Complete Reissue n 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:
ISA NCAC 0'#t1- i L 0 n Rules attached. ri''General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name ; : 't -v G C 1 n ,n, ,�"
App �F''Gtr; �.'r����� J�.� Authorized Agent , 1 V1 Ai aD�.
Address r """it÷ t'S )O Al. ( t,oc s/A,t ...,c'r Project Location(County):
City >j Gf ��U State /J ZIP c: S-7.)tit Street Address/State Road/Lot#(s) ? tl 4` 1,....r i f I et:-1' �s:)'tit`
Phone#( /:Y) 6170 . /;33
Email Subdivision -------
City &a,,..1 '( -'(,. ZIP G(3 ,
Affected I I CW n EW n PTA J.ES n PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): IDEA ❑IHA I1 UW n SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity Prop.`-S.c.7 /VD pie l' r.<" ,t I . '-/ l- ,-,:,,_(' fl-,Y:1::* /, -4-
(Scale:I11= }I)
Shoreline Length
� —Access Length +-
Pier(dock)length
I :— f 1 r k4 —
Fixed Platform(s) �+s _.%__.._[._ —.... _...... € ___
i
Floating Platform(s) 1 '
Finger pier(s) . ,.. ; 1,4 !--"
Total Platform area f P.vfVe- �r I '
f I
Groin length/# l t , " P'C•0. f , .
Bulkhead/Riprap length ) ...... .... ._..__.._ T
•
Avg distance offshore ..� € ! '- — j ' -
I i
Breakwater/Sill i (� I I
Max distance/length . t I
.
j
Basin,channel — F-'
Cubic yards r_T I�i •
, � d49 f �__, —
Boat ramp ( I /JO w att pL /�f;�1 C
Boathouse/Boatlift " / I ' ,
Beach Bulldozing ', l - I I f
Other
i �f05e44(o X40�a►CreS5'.'�f
SAV observed: yes no ` —
11'
Moratorium: n/a es no , • 4'04
''
Site Photos: / yec no/1El}/ ) ��
Riparian Waiver Attached: yes no �.
A building permit/zoning permit may be required by: y._:--` (. ,q.
}-� II TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions i; .. :;. ../2'.. L.,,, (1 ct,•t --:p l: lak i 0,,.ca.�(C,J
• i i r..' L{ : • ti i'; £kS i-:..J1 ,)( 4Oy l,Valt',c'n.'` S,A.E:S4r..: , (t.:% er: ,n See note on back regarding River Basin rules
r al-.: L ; L., t,,,,cttIL_'i v.vp,..4i 300(1,2 i) ', .x
nSee additional notes/conditions on back
r
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.4 (Please Initial)_ it ')
Agent ;Ok.Vt Y1 P 4401)
g or Applic�antlPRINTED Name Permit Officer' INTED Name
Signature**Please read compliance statement on back of permit** . Signature �� i
/.00 • ` . t/) r 2 172 7 i C_. .
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:
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

,t°"r"i !CAN IA..ICAA' Pl DREDGE & FILL No. 90037 ABC D
a- iGENERAL PERMIT Previous permit
Date previous permit issued
15,New N Modification n Complete Reissue n 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 n Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name I ......,I Authorized Agent
Address '• "—I—4'7r- I e i ;I ,- •� 3'Ai s' Project Location(County):
City State Ai(..., ZIP . • Street Address/State Road/Lot#(s)
Phone#(_) ,j3
Email Subdivision
City - ZIP
Affected n CW +EW n PTA n ES D PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): OEA IHA n UW I [SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity ;-);)c .CO(
(Scale: i .; )
Shoreline Length / ' ""
Access Length )1 " .i Pc4/40- ) ; - t 1
P
1
Pier(dock)length / ; `' ) r '{ ;1 f '
Fixed Platform(s) k + ,. `.4.�.`� a. ( l7 $ t 1
Floating Platform(s) ..."'
I r FF C,� ____.
J l 14
.�,,1
Finger pier(s) ( f � `��......_.
I
Total Platform area . I _. � Pne7x4 .... } { '
Groin length/# ) I _ C.�
Bulkhead/Riprap length 1.__ _(L�..._� —._ _
Avg distance offshore i `-- # l
I.
Breakwater/Sill — f -
; i ; 4>---I'-'''''''—'7
Max distance/length 1 1 ' 1 I ' . ` L
Basin,channel F
_....__ 1_ _ ...__f ,
Cubic yards i I i i al/4. ��
"r L E
Boat ramp ( i ti•-1.... E'-_.�, M,`)1 P
Boathouse/Boatlift
trams
Beach Bulldozing - �� i
;;: edn/a
Thu yesgg i te Photos: yes no f �__-' _ _..-___--I r._4ClT lil5.°S-?�400 �.. �. �_._I_..
Riparian Waiver Attached: yes no ........ 1 . I , F~- ; I j 1
t . !
A building permit/zoning permit may be required by: i " . , ''.-
[ 1 TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
4 „,,,.. n See note on back regarding River Basin rules
i
nSee 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:
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

,
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
1-7 Name of Property Owner: cti 4 tor J. Joc tr 0-ti -
Address of Property: 2�_s L ` ) 1 e T— 3)� $""' `*` A 16
rr ((Lot or Street#, Street or Road, City&County)
Agent's Name #:�l A .�roo k5 Mailing Address:
Agent's phone #: 2-52 — 2-4 I --I�i GS
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are roposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagement.net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
iI do not wish to waive the 15' setback requirement.
(Prope formation) (Riparia Property Owner Information)
re aQ Sign ure
Bro()lerc- Deng V'vrL - �fk/�E�21r� rt,c�/'�
Print or Type Name 7 Print or Type Name
#/CS C /A: it-At \ 234 c /"li IItiL( Pt
Mailing Address Mailing Address
Go I Jr p AI C- 27570 70 rt��04 9 e l y ,Jc Urn--
City/State/Zip � City/State/Zip
CI I - 920 ' jJJ� fed-rkgall(LA,(It e G/t¢-, L. . COM
Telephone Number/Email Address Telephone Number/Email Address 1•iv t;l-I V 1_+
/ - /6Y - 202 3 o f/24/7,0 23
Date Date
(Revised Au . 2014)
I ,i -: ri-$ti GI I Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Zrm G^'cet e.,n Cl/r ��r 's
(Name of Property Owner) 7
property located at 2 2 < U ; Ile F- .D r Zee AL, + ) ,E s
(Lot, Block, Road, etc.)on AL,: C T , in Bec T L / Cc r , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
�M I do not wish to waive the setback requirement.
/ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Lof
0c F
�t1 l J� �1y�H�
to4UI
M I l r r ..ri=/Go, Nor 16 Rive' i O
c_f�� S�4 )�
:15Z�1\14. "
t~
\a Sao'
of r �sl- r3
l5�
Sig ture
C20 picuLa_
Print or Type Name
''2 IA( 3g ct RFCFlvFD
Telephone Number
Date: 0(h /1.02
say L 4 zoz3
CCM Mr1EJ <;z 1 Y

❑DREDGE & FILL N° 90037 A B Ci D
GENERAL PERMIT Previous permit
Date previous permit issued
�y4}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 o ❑ Rules attached. ❑,-'general Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
.`.
Authorized Agent
Address
0, �'v o/A2f _^ 4-Project Location (County):
City State
!tf
ZIP '.)i.`., i)
Street Address/State Road/Lot#(s)
Phone # ( )
Email
Subdivision
City =jrgr,.i -( fX '(" ZIP
Affected ❑-CW ❑ EW
❑ PTA
❑ ES ❑ PTS
Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ IDEA ❑ IHA
❑ U W
❑ SPIMA ❑ PWS
Closes[ Maj. W[r. Body r' 1
ORW: yes/Ob?' PNA:
yes/no
Type of Project/ Activity
(Scale: I
Access Length
Pier(dock)length / IC)
.!
Fixed Platform(s)7.-iJ X r<,
I
i
(
_y`
4
_
11
o
1t�__-
n•A_
T_.—_(..
I
l
i
.
'1f
-
1
n
eMr f
Floating Platform(s) e
--
-
Fingerpier(s) ,�...-•
_
L_—
j_...
_
�
!
)o
X'.
Total Platform area '• CO' f / 7
Groin len h/#
Bulkhead/ Riprap length�-
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channeli
Cubicyards
I
-
/
I
Boat ram '
Boathouse/ Boatlift
Beach Bulldozing
Other �
T.T._
I•
_
L-
^
_ 11)
J'
r
W
....!
4Sv�l
_L
:rt
[
VgCr
.:_
-r
_j
{--
�,.,_
-
_—i
!
_.,r
`l
_
"T
r
c4'
1[PM_
41
_
-
- _
_i_.
—j—
SAV observed: e
yes
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached yes no
r
-
-
A building permit/zoning permit maybe required by: <1.('>/h+
(J ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions :,.t r;(zh.. �-t.4'�c.. /o ct•�C{ u-.a its P7C4lxo,xRcf
is %ti SAP of 40tL-1 (z.ati'(Gnt, Sin.(-,Sj i.,:, ct.nnpn.rcw��¢�- ❑ See note on back regarding River Basin rules
'/,� i�Arnt(P[t r... n- A.i} C.,P.e�e..e91
`0 ❑ 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) i ;1. i 1
r
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
Signature
Feels) Check#/Money Order Issuing Date
Expiration Date

dCAMA ❑ DREDGE & FILL N9 90037 A B C D
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:
15A NCAC U '� t ` C'y i ❑ Rules attached. ❑ General Permit Rules available at the following link: v .deq.nc.gov/CAMArules
Applicant Name ('ift+ i-) (4t r.( SJ Fc s (;'� �: -) - Authorized Agent '5, iG) ✓s �''0 OiA,
a.,�_ -. i
Address "`'-�--mod:' "'1'af Rsd, i(7� ", � :> >++l r �,l' Project Location (County): � /�_s. (-t=1-k "r
City State AIL ZIP Street Address/State Road/Lot#(s) II '-
Phone#313
Subdivision
City zip :,<?et...)�G
Affected ❑ CW ❑ EW ❑ PTA OS ❑ PTS Adj. Wtc Body �I (nattman/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wen Body '
ORW: yes/no, PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock)length
1.1V
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Total Platform area 0
Groin length/it 1"
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 r<
Permit Conditions
(Scale:
u inryr+irprvowy c.rrcnne)
❑ 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
I
Application Feels) Check tf/Money Order Issuing Date Expiration Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: -4) Cu ATo, r61� Jeat\ L TIL
IT
Address of Property: 22S f _)> 0 , J IIt. t
(Lot or Street #, Street or Road, City 8 County)
Agent's Name #: 1t1 $r-co kS Mailing Address:
Agent's phone #:
252 - 241-9190i 5
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 roposing. A description or drawing with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htta.,//www nccoastaimanagement net/web/cm/staff-listing orbycalling 1-888-4RCOAST.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope formation)
re
Jfd ('
Gvl Dee b l v r l T.
Print or Type Name
/Q5 /V C / jot-na s�—
Mailing Address
Go 1" p f /(/G z 7530
City/StatelZip
Cl 1 `I - 92CJ
Telephone Number/Email Address
/ -1Y - 202.3
Date
(Riparia Property Owner Information)
�"�----
Sign tore
Print or Type Name
230�' -M« ojt/ F'G
Mailing Address
rt�k� l e I rJi Tg in-
City/StatelZip
Ib
�ItrJ i Q¢1)/ 1 c u 6f e Gr"A-, t- - cor)
Telephone Number/Email Address Iitrp'IV> i.s
Date
(Revised Augg.�2014)
LN'm-mmt.) s_;17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to !)rm 64"IJ Dg,,(� Cr✓r
(Name of Property Owner)
property located at ' ZS i ' ; I )e C )-
(Lot, Block, Road, etc.)
s
,�'-r.F-:) ),
on .. i� i ;-c i' in Deck T ic, %�;e+ , N.C.
(W'aterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
�M I do not wish to waive the setback requirement.
—1— I d4 wish to waive that setback requirement.
DESCRIPTION ANC/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�U' `tiiY �Y ti
> 1`
(roilf( 5
I
r A
i
-- -may ------------------- -- --
/- o- i�,
Ito
V )r
. ltt'-
Sig tore
7A�e2�9 �"tt�ce2
Print or Type Name
Z(ti 241 '� g �4
Telephone Number
JAN `� 4 O'Ll
Dale: 0I/2q/U�3 -
t71. hl---'kt`mct

ADJACENT RIPMLA.N PROPERTYONNINTR STATEM-ENT
(FOR A PIER/MOORING PILWGSIBOA TLIF-PROA MOUSE)
nere" Ceruly Ina; 1 :%kr pro�el��
A.,1111c of property ON� 11cl-)
7
(Lot, BInck, Rand, etc.)
'«aivrbod3') (Ta"n anlor County)
10 ram MAN& w pw nx Won How he dwwp:rhe IS
I TiL— -) zo I :r},-c a
Qnyhoal"IbeApm man be $r;: 7,Ck. a M:rim�:m 6,sf?-Tcz- 07 rikern feet 115'1 Worn ry are..
A mparian access umess wSked w.v TC.
I d&L p-Qt vish to ,vai%v the sWack requyemew
41- - -- : en-�:;h :n t-,7 �
DF�1,101MON :AND OR DR [%�G OF ITION)SED DES LLOPN I f _ N r T
----------- -------- - - -------- - —
S lag FE� e w V: rkc r
Pnn: w T) pe Na-

■ Complete items -I' 2, and 3.
■ Print your naine�nd address on the reverse
so that we cariTeturn the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed to:
TGnc.l M.t►e� N���p
2308 Emeltn� 1 L�
Mor�lcrd C'.E� NG 2g5s7
9590 9402 7272 1284 3969 35
2. Article Number (transfer from service label)
n. aiyum �
n -
❑ Agent
X
❑ Addressee
BA�R ved by (Pnnfed Name
C. Date of Delivery
l 1�72/'rj I l.G.:' 2.
D. Is delivery address different from Rem 17
❑ Yes
If YES, enter delivery address below:
❑ No
3. Service Type
❑ Priority Mall Express®
O Adult Signature
❑ Registered MaIPe
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certilwd Melia
Delivery
D Certified Mail Resldcted Delivery
❑ signature Confirmation'°
❑ Collect on Delivery
❑ Signature Confirmation
❑ Collect on Delivery Restricted Delivery
Restricted Delivery
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PS Form 3811, July 2020 PSN 7530-02-000-9053 Domestic Return Receipt

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United States
Postal Service
First -Class Mail
Postage &Fees Pald
USPS
Permit No. 0.10
° Sender. Please print your name, address, and ZIPW In this box*
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Lot or Street #. street or Road. City & County)
Agent's Name #:' ^ y Mailing Address:
Agents phone
> 14-
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 hace no objections to this proposal __I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httn #,www nccoastaimanaaement netiweb/cm/staff-listing orby calling 1.888-4RCOAST.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback. you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Oy er Information)
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Print or Type Name
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Vailing Address
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Gty/State/Zip
Teleprone Number /Email Address
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(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
Crty/Statelzip
Telephone Number / Email Address
Dare
(Revised Aug. 2014)