91413C - Bolton, William

0,40(-`) "4,r,4 CAMA n DREDGE & FILL No. 91413 ABC D
1 GENERAL PERMIT Previous permit
Date previous permit issued
n 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• i 1 Uv n Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
-), i1OvN-S „�4l" r),ApA is_ Lk'15CLI ' 'I'', `�,_ /
(,Applicant Namely/ 111& kfi, Bc 40 ) Authorized Agent —r--A ill� , c 'f-w/"3 (3)a/
4111
Address I/0 (Iti 1/ct,1-k 4-et,' *NA_ Project Location(County): �a^/�+4- " 4e /- v
City -auA-`ate State Al C. ZIP 2X5�(p Street Address/State Road/Lot#(s)//0 76,26,
Phone#(Mt) 332 - S()U ( I%W✓vbS) /
Email 6'0 1 b t�Ag ,tm. 6 1 TDB t c,i t Owl S 1 Subdivision G a L''4.'^`4S 01" -
City BP • ' ZIP 2(-51e.'
Affected CW �EW x J PTA n ES n PTS Adj.Wtr.Body 'V2u-f(f`/4- e't"e - /, qa man/unk)
AEC(s): I I OEA ❑IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body lU les✓ - P, I,—Qf
ORW:yes/no PNA:yes )/
Type of Project/Activity /'66� i 4 e r,c. /,p r (4 S 9L #c )
(Scale:' ,so )
Shoreline Length QQ 4
j 1 1 1 I ' I
Access Length _.---- N 4' - —. �— -_ 4. Cam ._._.... ..
1�INCI� �
Pier(dock)length '------ I I
Fixed Platform(s) "fir ,
Floating Platform(s) / Oi r p - O d a O d! ? e
J —._ Ny1
Finger pier(s) ;
{ i
e[C 6
Total Platform area /�'
L..il
Groin length/#
Bulkhead/Riprap length 1 -
.-..i.._-__---�---- 1 ----.—. .._._.__ --------
Avg distance offshore _ } -- 7)s� _-_._._-
Breakwater/Sill I + i I }
Max distance/length --� I 1 I :- ? 4
Basin,channel I ' I i
_.. ..._
Cubic yards /'/ I , f- -__..__. t--..._..._
___
Boat ramp i' l
Boathouse/' oatli 1.3 X/3 13 X/S I •
Beach Bulldozing in I
{ a I
i
Other L✓� MG✓ N
SAV observed: yes A ( '
Moratorium: n/a yes + j 'A SO CA df F-ilt.. ,
i
Site Photos: e ,' t
Riparian Waiver Attached: es no - / i _
A building permit/zoning permit may be required by: _b/L o YeAv�C rr 4"
Permit Conditions kV( t",ofk.. c l :-:el ( -a-,c, l9 rid,`ttt��� e fh`� Y� n TAR/PAM/NEUSE/BUFFER(circle one)
nSee note on back regarding River Basin rules
ElSee 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.P.(iINTED Name_ '
Signature**Please read compliance statement on back of permit** Signature
Zou. . 7Z / z� 10 / Z2 /
A lication 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

'o�°�`tOASt tI ICAMA I I DREDGE & FILL No 91413 ABC D
vg
GENERAL PERMIT Previous permit
Date previous permit issued
New I I Modification I I 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. I 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): I I OEA IHA UW SPIMA PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity 404
(Scale: ' s`.,- )
Shoreline Length 'f
Access Length , d, —�� r,, ti .. _ ..._..__ ..—� �._.
Pier(dock)length i I I T
Fixed Platform(s) ? �. � .111111
� I •
i I t1e {
Floating Platform(s) i ! I 0 v I `�" ® q .
\J I :, __ !, i 4
ca.
1
Finger pier(s)
..b „„„,, ..
Total Platform area
Groin length/# I ) 1Ill I
Bulkhead/Riprap length - i i I _�
Avg distance offshore i., i_ ..._...._. v,,�; .,.._....Dot-'} j ........__... . ......__ . ...,._._._ •
..
{
i i
Breakwater/Sill �r * ? 1
Max distance/length — 3
Basin,channel .� 5 . — j t '
Cubic yards _.//�
Boat ramp ( I '
Boathouse/Boatlift .' t 1 1 } I
la'
Beach Bulldozing i 1 F
Other
1 1;
-1 A4G( I
` I .
SAV observed: yes no`i I ' (ldc,1 co 3 I ' �
Moratorium: n/a yes no 1 h� „J,•. _ C, !y'. ' CN ". 1
Site Photos: yes no j - -
Riparian Waiver Attached: yes no ` ( I I i i 1 ,
.® i I
A building permit/zoning permit may be required by: - �}Oa:.
Permit Conditions TAR/PAM/NEUSE/BUFFER(circle one)
v
II 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:
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

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Gallants Landing HOA Authorization
Name of Property Owner Requesting Permit: William E and Katy C Bolton
Mailing Address: 110 Gallants Lane
Beaufort, North Carolina 28516
Phone Number: 828-337-5087
Email Address: [e-mail]
I certify that I have authorized Owner
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: adding Boat lifts in
Slip #6 and Slip #5
at my property located at Gallants Landing
in Carteret County.
I furthermore certify that I 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 the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Ga is an g HOA
Signature RECEIVED
Vick C Moore
Print or Type Name UUN 1 4 202.i
President DC114-MHD CITY
Title
06 / 09 / 2023
Date
This certification is valid through / I

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: William E and Katy C Bolton
Mailing Address: 110 Gallants Lane
Beaufort, North Carolina 28516
Phone Number: 828-337-5087
Email Address: [e-mail]
I certify that I have authorized same
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Addition of Boat Lift in Slip #6
Gallants Landing, Beaufort NC 28516
at my property located at Slip#6 (also own Slips#3,4,5)
in Carteret County.
I furthermore certify that I 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 the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
/y1
ignature
William E Bolton
Print or Type Name
Owner
Title
May/ 9 I 2023
Date RECEIVED
MAY 0 9 202'3
This certification is valid through I I
OCINI-MID CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: William E and Katy C Bolton
Mailing Address: 110 Gallants Lane
Beaufort, North Carolina 28516
Phone Number: 828-337-5087
Email Address: [e-mail]
I certify that I have authorized same
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Addition of Boat Lift in Slip#6
and Slip#5 Gallants Landing, Beaufort NC 28516
at my property located at 110 Gallants Lane, Slip#6 and Slip#5 (also own Slips#3,4)
in Carteret County.
I furthermore certify that I 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 the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
efts a RECEIVED
William E Bolton
Print or Type Name JUN 1 4 202•4
Owner
Title ()CM-MHO CITY
Junes i41 / 2023
Date
This certification is valid through / /

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To: Wayne Hall — Division of Coastal Management
From: William E Bolton
Date: June 14, 2023 RECEIVED
JUN 14 '1i/
Ref: Addition of Boat Lifts in Slips #5 and Slip #6
DCWI-A4HDCATy
Gallants Landing, Beaufort NC
Included:
• Gallants Landing HOA agent approval
• Agent Authorization CAMA Permit Application —W E Bolton
• Adjacent Riparian Owner Notification — Beaufort Resorts LLC
• Adjacent Riparian Owner Notification — Town of Beaufort NC
• Adjacent Riparian Owner Notification — 103 Broad St LLC
William E Bolton
110 Gallants Landing
Beaufort, NC 28516
828-337-5087

William Bolton
From: Hall, Wayne P <[e-mail]>
Sent: Wednesday, May 17, 2023 11:13 AM
To: William Bolton
Subject: 110 Gallants Landing CAMA permit
Attachments: DIRECTIONS FOR OBTAINING A CAMA GENERAL PERMIT.pdf
Good Morning,
I received your permit application for adding a boat lift to your existing slip in Gallants Landing.You will need the
president or managing member of Gallants Landing HOA to sign an agent authorization form allowing the proposed lift.
Additionally, you will need adjacent riparian notification forms from Beaufort Resorts LLC and the Town of Beaufort. I
would also request that you obtain one from 103 Broad Street LLC.
Thanks!
Wayne Hall
Field Representative
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
[phone]
[e-mail]
www.deq.nc.gov
RECEIVED
Find a Field Rep (arcgis.com)
E- _ ElIUN 14 1Q1
1 �
prVartlIke.R.f t m u QUMRty
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
i

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: William E and Katy C Bolton
Address of Property: Slip#6 - Gallants Landing
Mailing Address of Owner: 110 Gallants Lane, Beaufort NC 28516
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: same Agent Phone#: same
Agent's Email: same
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.
Slip#2-Gallants Landing
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)515-5400. 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
N/A
Signature of Adjacent Riparian Property Owner
OR itiiC .j1/
I do not wish to waive the 15'setback requirement(initial the blank) N/A MAYO92
Signature of Adjacent Riparian Property Owner: iej `� y2.4/` oc41.. J
My
Typed/Printed name of ARPO: Vick Moore Q Cf -,,
Mailing Address of ARPO: 112 Gallants Lane, Beaufort NC 28517
lcf-Zl —V 2�
ARPO's email: [e-mail] ARPO's Phone#: v �(//4(
Date: May 9, 2023 *waiver is valid for up 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 William E and Katy C Bolton
Address of Property: Slip#6- Gallants Landing
Mailing Address of Owner 110 Gallants Lane, Beaufort NC 28516
Owner's email [e-mail] Owner's Phone#: [phone]
Agent's Name same Agent Phone#: same
Agent's Email: same
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.
Slip#7-Gallants Landing
If you hate 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) 515-5400.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
N/A
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank) N/A
Signature of Adjacent Riparian Property Own lr✓ ti U CC] i- r:ytec YoJ /.4 &-
Typed/Printed name of ARPO: West Fowler RECEIVED
Mailing Address of ARPO: 108 Gallants Lane, Beaufort NC 28517
ARPO's email: [e-mail] ARPO's Phone#: [phone]
MAY 0 9 2023
Date: May 9, 2023 *waiver is valid for up to one year from ARPO's Signature* DCM-MHD CITY
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: William E and Katy C Bolton
Address of Property: Slip #6 - Gallants Landing, Slip#5 - Galants Landing _
Mailing Address of Owner: 110 Gallants Landing, Beaufort NC 28516
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: same Agent Phone#: same
Agent's Email: same
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) 515-5400.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:
Typed/Printed name of ARPO: Beaufort Resorts LLC
Mailing Address of ARPO: 3301 Benson Drive #103, Raleigh, NC 27609
[e-mail] 919-422-2903
ARPO's email: ARPO's Phone#:
Date: 6-8-23 *waiver is valid for up to one year from ARPO's Signature*
ftrlay 2021
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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 portion to be completed by owner or their agent)
Name of Property Owner William E and Katy C Bolton
Address of Property: Slip #5 and Slip #6 Gallants Landing
Mailing Address of Owner: 110 Gallants Lane, Beaufort NC 28516
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: same Agent Phone#: same
Agent's Email: same
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
descriptionon or drawing,with dimensions, must be provided with this letter
V 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 /f ,061...../
S. a of Adjacent iparian roperty Owner
OR 14F-+CEOVF, t
I do not wish to waive the 15' setback requirement (initial the blank)
'JUnI 14 /fl/
Signature of Adjacent Riparian Property Owner:
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Typed/Printed name of ARPO: Town of Beaufort North Carolina
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: eto/dq a6;Z3 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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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 portion to be completed by owner or their agent)
Name of Property owner William E and Katy C Bolton
Address of Property: Slip#6 - Gallants Landing , Slip#5 - Galants Landing
Mailing Address of Owner 110 Gallants Lane, Beaufort NC 28516
owners email: [e-mail]}wners Phone#: [phone]
Agent's Name: same Agent Phone#: same
Agent's Email: same
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent 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 wilting 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) 515-5400.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 someiall of the 15'setback 741
1' " �,��- .
OR- Signature of Adjacent Riparian Property Owner R C EF V ,
i do not wish to waive the 15'setback requirement(Initial the blank) N/A JVN
14 207R
Signature of Adjacent Riparian Property Owner. --- �-^--'�� OCM-b
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103 Broad St LLC b CITYTypedlPrinted name of ARPO: y Lyle D Gardner
Mailing Address of ARPO: 7706 Six Forks Road, Raleigh, NC 27615
ARPO's email: / 1 �d J t r A Cr- 'n�ARPO's Phone: / - ZZ 'Z (
Date: tD/jZ ,. * waiver is valid for up to one year from ARPO's Signature*
! Revised May 2021

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