92906C - Convoy, Chene

is Nc. A f._-i DREDGE a FILL NO. 92Z9Ct6 A . © o
GENERAL PERMITii
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Bulkhead/Itiprap kergth ' — .--- '-- .--' �- ; I ---!--` i 4 - ... - ----.---a-.!
iAvg dstanceoffshore — -4- 7C---' -- .L_ - I., , -- •-• -1 i : - --- ) ---1-i-"
Max •
Brealturat
distance/ rr-- - - -1------4- rt'_I_ ..1.. . ...., __.._,_.ti_.1....'� �_ •---I-I+}) f 1.+,,
Basin,eannel — t. t �- Ile..- -L�--t \t-��r- -iT- -�-_t- --ate--`--'---1
ram_,_•_ _ _L_- _ —_ r 1 - -_ i.-�-
Boat ramp f l ( r _ I
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.,. � 1 ;zing
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SAV observed: Ya -+ --.
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Permit Conditions_refs I /theft % w•r._/, !io >litlt-�• N.l•..•', f +•► 1 fa$4144 vul(i1M1 us�BE)FrtR(c>td.a..)
_- --- _ _- El Sne role im bail searing!Arc Havre mods
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IAM MUM OI MUTES,QCMATS-_COMMONS 111IfrAIld1011BS MOW AIM RVtY 000MPUN10ESIMI ENT. (rime Initial)--W
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Signature•• ease read compliance statement on bock of permit•• Signature
gao0� I2G63 3%2� 12� 7
Application Fee(s) Check r/Money Order bsu nd Eaprraaon pate

o�ot°"sr/NNCAMA I I DREDGE & FILL N9 92906 A B 0 D
3
: GENERAL PERMIT Previous permit
Date previous permit issued
IX New n Modification Complete Reissue I I 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:/4 15A NCAC 07 , 12OO ❑Rules attached. ® General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name C 11 /09 P1 C-oh VV y Authorized Agent / Ve - /1v liS o/ 7
O2t Address O lt L/
n A h hC ( n a.n /�/ l r/1/e Project Location(County): C 6e1 veil
e
City /VCR" ✓6Cvl State /V C ZIP 2g56 A Street Address/State Road/Lot#(s) AO C/ C LL't h A A e I I-+"1 Y g.'/i/`/'
Phone#( /Iq) / 75 -06A8
Email C 4/14, 7 7 (`., t'÷rh,R;1, G."1 Subdivision //�J"
City 1/(v [Xs,"'✓l ZIP g-0 C.‘,
Affected n CW XEW ®PTA ES PTS Adj.Wtr.Body Tv.,,n c)4 A/✓e- beh d C" 'i/ (nat unk)
AEC(s): Il OEA n IHA I 1 UW I I SPIMA PWS Closest Maj.Wtr.Body / vCw1-- A tl VC v
ORW:yes0 PNA:yes/so
Type of Project/Activity P✓'iosici, -P to 14-1.1, boar I/74 4
n (Scale: A/73)
Shoreline Length �f�/, 9-9-
Access Length
Pier(dock)length fP(,
Fixed Platform(s) PL
r.—. L
Floating Platform(s) ttg'X0.O' 06,
e.- art"' t-VA''
Finger pier(s) "--- 100,4 I/ff'
Total Platform area 16O fp�`�' Moil ;
Groin length/# — vvv /( ?-S
(Ives i of l)
Bulkhead/Riprap length
Avg distance offshore — P L
Breakwater/Sill y /
Max distance/length ' e)e(5 Al, 4,\
Basin,channel
Cubic yards / \ C'—.
Boat ramp
Boathouse/Boatlift / \ f ecio5e'J
Beach Bulldozing Qi v�
Other ( 5 Ii, Gi. "lt,pv:Z'P1 \ o /�
/ �� Fblomim;
SAVobserved: yes n / GSI, MIK 4 \ "�h�11
Moratorium: n/a yes
Site Photos: yes 6) PL Yoi...na'f' 4/✓6✓ emj ft.) Con�"`l'
Riparian Waiver Attached: 0 no (wq/vcd�
A building permit/zoning permit may be required by: TOw✓1 o 7"/ 4//"/e✓' 6 a.- I
Permit Conditions To I-n I /1 1-5e n rC q of I do p$/¢- nti� no vti o✓C T�1^.1 3,fR SQ TAR/PAM ��:UFFER(circle one)
-- - n See note on back regarding River Basin rules
riSee additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.
ESTATEMENT. (Please Initial)
/�
Agent or Applicant PRINTED Name Permit
tOfiOffcer's PRINTED Name
Signature**Please read compliance statement on back of permit** Signature
Application Fee(s) Check#/Money Order Issuing D e 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

0"m1", I ICAMA DREDGE & FILL No 92906 A B �c D
fPrevious permit
4GENERAL PERMIT
aDate previous permit issued
New n 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:
ISA NCAC 6 l Ii, I ou I I Rules attached. El General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name ( ; .Pi v ( `f / Authorized Agent i v.7 {- , , ,_ /-><-
Address v c I14,,,h f\C ( L,i / Or,"✓( Project Location(County): - `)Iss,Cvl
City /VC 11)_,,vi State // ZIP .S�2, Street Address/State Road/Lot#(s) IL y ' ^ r't- i / ..,°l .9 ✓(
Phone#( /1'IO 4 7 i - 06 E
Email 2 7 (//�! /`-4- h,1, ' '`) Subdivision .
City 11/(`� i3 -✓i ZIP A b' `.
Affected fl CW EW F PTA fl ES PTS Adj.Wtr.Body s ,-s c/ - 0_h J ''". / (nat h unk)
AEC(s): OEA n IHA n UW ri SPIMA n PWS Closest Maj.Wtr.Body / " / /1 I vC v
ORW:yes/no PNA:yes/,no
Type of Project/Activity a, 110 1' 0 j>. i I '7L -1
(Scale:A/j 4)
Shoreline Length
Access Length ,
Pier(dock)length ' 1
Fixed Platform(s) ` ,_ 1.
Floating Platform(s) t 6 f
Finger pier(s) i ''
Total Platform area : • .. .a , "IN 4
Groin length/# . ._ _ .-_. _-----.(iyG i-< i--
Bulkhead/Riprap length
Avg distance offshore '
i fL
Breakwater/Sill . _._ ; '_""-i ; ply. . - .-.
Max distance/length ,t.
! !
Basin,channel '
Cubic yards _.
"
Boat ramp ------
Boathouse/BoatliftI 1 P"'"lc
Beach Bulldozing / I
Other I �'x
�.. I `___bk 1441
SAV observed: yes ( ,
Moratorium: n/a yes rho - 4 •+ a
Site Photos: yes no c -i —i_�G_h..✓"`j
Riparian Waiver Attached: .GeS no ? i , . p _
A building permit/zoning permit may be required by: / , /,. ,. :" f "' J
Permit Conditions f ;, ,. ,t ,, - - ,j
,,,, ,,,., ,; - i 11 H . i {I TAR/PAM,1 dEUS UFFER(circle one)
nSee note on back regarding River Basin rules
[I 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)
V
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

��`°"'") ,ICAMA I I DREDGE & FILL No 92906permit A B -.0 D
GENERAL PERMIT Previous
Date previous permit issued --
n New 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:
I 5A NCAC i I 1 Rules attached. IJ 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) i. , ✓
Phone#(_)
Email Subdivision
City ZIP
Affected n CW ` EW n PTA ❑ES n PTS Adj.Wtr.Body (nat/nwl/unk)
AEC(s): n OEA n IHA I I UW n SPIMA n PWS Closest Maj.Wtr.Body < < 4
ORW:yes/no PNA:yes/no
Type of Project/Activity . - -
(Scale: A/1 4 )
Shoreline Length
I I E
Access Length -d-.., i C
e, ! j
Pier(dock)length i I I i
Fixed Platform(s) i ! 1 t
5 .. Y._..� 44,.........
'
}
Floating Platform(s) 1 II
i n I I I,
)` - .14 w
Finger pier(s) i'
E
I I
•Total Platform area ; - i I t 1 I I I, N ,
Groin length/# - i i . - I ,h t , '' i f • -k 0'
Bulkhead/Riprap length _;.- _._._............. .. ._ }.. __....._.. . . a._._.. __.____-f.. �_
Avg distance offshore t i. .._I_ - --4 --} -* s�
i
Breakwater/Sill - y , a 1 . I } ,----;, s /'°
Max distance/length `A i i.�l
Basin,channel ' ..i. F ‘ ' t
Cubic yards r ._ �.___ �.. _ y 4-. ;__
, t 1
Boat ramp i E I i A I,i
Boathouse/Boatlift I I w _ s,-! . ' D 1.i C
Beach Bulldozing i I
Other _ J i L
SAV observed: yes no, '— - ,1 I 1-v-'-1 \ I I I --'
Moratorium: n/a yes no ) 1 1 J. ; i i I
Site Photos: yes no .. t. _ .._.. .._.+. .,.,, -4�.._._.0- .__r..-t, ` rr� .. - _rL"`a
Riparian Waiver Attached: yes no , ! - 1 I I _fr 4 l
F J
A building permit/zoning permit may be required by: /.
Permit Conditions 4E TAR/PAM/NEUS9BUFFER(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 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

12' (144")
4
EXISTING BULKHEAD NA
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EXISTING WALKWAY ox)z
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NEW BULKHEAD m FLOATING tBOAT LIFT z
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AVA
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 SI
0...eperty Owner Apply' for Permit:
Mailin Add
Rt., onne I 121/111 Dr
lUCIA.) (3ar rvG a -1,4 .
I certifythat I have authorized(agent) ire SC 1 tto act on
( � } my
behalf,for the purpose of applying for and obtaining all C MA Permits nece ary to
teinstall or construct(activity) 5004/0 0k lit 1 t1 e
at(my property located at)cb t ')crf k 1114frri Pr .
New foci..
This certification is valid thru (date) 2 -N a 3 .
awl&1 evAA.A.Aci iq ( 3
Property Owner Signature Date
400 Commerce Avenue,Morehead City, North Carolina 28557
Phone: [phone]\FAX: [phone]\Internet: www.nccoastalmanagement.net
An Equal Opportunity\Affirmative Action Employer—50%Recycled\10%Post Consumer Paper

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: CHENA CONROY
204 CHANNEL RUN DR NEW BERN NC
Address of Property:
Mailing Address of Owner:
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: TRENT PRESCOTT Agent Phone#: [phone]
Agent's Email: [e-mail]
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.
XI 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 ad,„„x,
Signature of Adjacent Ripan n Property Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner: I ,t1r2fr%IJL
G4eWYri
Typed/Printed name of ARPO: DELANE JACKSON
Mailing Address of ARPO: 45 SHORELINE DR RIVER BEND NC 28562
nC
ARPO's email: •manger@riverbend,moj RPO's Phone#: [phone]
Date: 3 ? 1 ' 3 *waiver is valid for up to one year from ARPO's Signature*
Revised July 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: @A . I Ocll(bj �(�WV-) A�►\D1l 1
Address of Property: ,)( -1 l. -V.f_i� Irk �tf1 LA.—) Cl )C g8S(pa-
Mailing Address�o�f�ow`ntec t2t Ohc ile'% w DC r'k I. [�s f' w G- a2610?
Owner's email:CA lt-11 T?g tit.8,4, er's Phone#: LI (LI 9 -Clc.O .
Agent's Name-Vert 1' ii eStbit Agent Phone#: ra X? 8 9A- i13-g
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comoleted 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
- I DO NOT have objections to this proposal I DO have objections to this proposal.
ff you have objections to what Is being proposed, you must notify the N.C. Division of Coastal j
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 1 ¢ k•7,72"// :e\_,0
f Adjacent Rparian P7cp.tfjr
-OR.
I do not wish to waive the 15'setback requirement(initial the Monk)
4 Signature of Adjacent Riparian ProoOwner, 7,
5 ',
Q
Typed/Printed name of ARPO:�ti /r• AiliAl i.---
�,, �� s%,) '� Ik Cl ot/7/#1-3 fir
Mailingof ARPO: � P
,. Q s i944-erlivitiy1 G au `Pnoniell: a/- 9y g
Date: ' 672 *waiver is valid for up to one year from ARPO's Signature
Revised July 2021
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TOWN OF RIVER BEND
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4 CHANN L UN DR 117E
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Craven County does NOT warrant the information shown on this map and should be used ONLY fortes assessment purposes. Printed on Febmary 22,2023 at 12:35:56 PM N

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: �/)' (- YI Cl (.C'),/Y'O1/ C 1/k( (Olin/( 60//Obli
Address of Property: *'L/ 1 G--1/10 C/ :-t /)y 4/e '/3 it /1/Z. Zf 5 2
J-
Mailing Address of Owner:
Owner's email: C i,f91( 771 0‘1t4/n'l. "11Owner's Phone#: Li/`-/-C 75 a 1 Y
Agent's Name: / �^"� fl)°SGdf Agent Phone#: " Z�/5
Agent's Email: 61)Mt.+497e 4 tWlc,/Liwn
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
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:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 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: Cj heI/i& )i' r ✓OV
Address of Property: Zvi/ ChaY1 nO1 k(i Dr ,l/ e w )3 Py1 VG
Mailing Address of Owner:
Owner's email: Owner's Phone#: ‘-'//Ll - 7 7,S" CGZK
Agent's Name: Chi Hy 7 hofrtti%/. CC-MI Agent Phone#: Z 5 2 - f 3fg- 2`/5fj
Agent's Email: t5P✓h A-cJie t oy75 tttic#4,9 co r'?
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
Signature of Adjacent Riparian Properly 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:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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Craven County does NOT warrant the information shown on this map and should be used ONLY fortax assessment purposes. Printed on August 24,2023 at 8:25:22AM

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