89756A - Rivas (MOD)

atwhOCAMA ❑ DREDGE & FILL NY 89756 B
GENERAL PERMIT \ Previous permity
¢ Date previous permit issued
New odifflc tion ❑ Complete Reissue ❑ Partial Reissue
As authorized by the.�Sjare `Z of aanz
,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
/
SA NCAC T7 r ' ' 1 Rules attached. Mr<,-eral Permit Rules available at the following link: wwwdea.nc eov/CAMArules
Applicant Name _ i ^ Authorized Agent a A a. C I ta,! C n w S 4f L&Ai S^
Project Location (County):
City G t'a-4-A o-
State'�ZIP Z E/ SS 7
Street Address/State Road/Lot #(s)
-T R /7 CN 11, k0 4 y .3 ,t S
Phone # (Ptj) % I
- -2- C. 2 i
/ Z V (-s,;s +
A V Q,
Email el,riytas
� PL (2Q iwI / c.Jnti
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Subdivision p f'4 iAl a
'D 0,M PMA-k
city M 0% -gQ �
ZIP Z7 !Wl
Affected ❑CW
NXW ®PTA ❑ES ❑PTS
Adj. Wtr. Body o/ Ao
�a.SO n an/unk)
AEC(s):
❑IHA ❑UW ❑SPIMA ❑PWS
Closert Maj. Wit, Body �KCA0.^ E/'-- -sac&.o4
ORW: ves(/
Mn,
PNA: ves nio
Shoreline Length : r7 9 're- 1/(-'S
Access Length
/�_ V
Pier (dock) length In 7C s _ _ _ L y"
Fixed Platform(s) a2 xy� O � - `
l7'�17' SR(3�l/N <F
-Flealin�Pla�t(orm,(s) /,c=cJtr
!!o
Finger pier(s) _
Total Platform area
Groin length/#`V�
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
E SX R
Boat ramp
As�f TF
Boathouse/ BoatliR
-
Beach Bulldozing
r _
Other a
SAV observed:
Moratorium
yes io U
e no
Site
Photos:
Riparian
no
Waiver Attached:
y s
i
A building permit/zoning permit be required by:
Permit Conditions E)L
I S T/AI ri - j jni Q S
t. 0 t a s o 1�:Q
a ek— E'X / s f i A) C
il
Et
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROII
Jillian Kalis
Agent or Applicant PRINTED Name
Sig azure **Please read compliance statement on back of permit --
Application Feels) Check #/Money Order
� {liPii /�OxC/C�r
'I,:.. (Scale: N7,5)
o-GCQSS t..la-f'
❑ TAR(PAM/NEUSE/BUFFER (circle one)
j ❑ See note on back regarding River Basin rules
T, ❑ See additional notes/conditions on back
(Please
Permit Officer's 's PRINTED Nam` ?/ //
Signna ure
(0115A3 /a/S—A3
Issuing Date Expi ation Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: David Rives
Mailing Address: 115 Lakeridge Drive
Gretna, VA 24557
Phone Number:
Email Address: [e-mail]
I certify that I have authorized JillkMif iWiEhane Clark Construcion LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Rebuild pier, construct new .gazebo,
repair bulkhead.
at my property located at 128 Forest Ave. Manteo. NC
in Dare County.
1 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: -�
Signature
David Rives
Print or Type Name
Owner
Title
l Z3 Z
bate
This certification is valid through

F
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u

N.C. DIVISION OF COASTAL MANAGEMENT 11,p
���
ADJACENT CERTIFIED MAIRLIARETURN RECEIPT NOTIFICATION[WAIVR
DADEEIIVERYYY' 1/ �D
(Top portion to be completed by owner or their agent) MAY 0 8 2023
Name of Property Owner: David Rives ---DCM
DCh —EC
Address of Property: 128 Forest Ave Manteo NC
Mailing Address of Owner: 115 Lakeridge Dr Gretna VA 24557
Owner's email: Owner's Phone#: [phone]
Agent's NameAllian Kalis / Shane Clark Construction 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
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.G. urvrsron or t,oasr I
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
1 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
fe7o
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Charles Brown
Mailing Address of ARPO: 23223 Hanging Tree Rd Courtland VA 23837
ARPO's email:
Date:
ARPO's Phone#:
*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: David Rives
Address of Property: 128 Forest Ave. Manteo NC
Mailing Address of Owner: 115 Lakeridge Dr. Gretna. VA 24557
Owner's email: jdrives6Cckimail.com Owner's Phone#:
Agent's Name: Jillian Kalis Agent Phone#: [phone]
Agent's Email: jilliankalis anshaneclarkconstruction.org
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 forthis
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.
. N/ 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one)
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: I A. / d*-�
Typed/Printed name ofARPO:Paul Williams DivisionthV!ronmental officer
North aro ina Department ot Transportation
Mailing Address of Al schooner Landing Dr., Edenton, NC 27932
ARPO's email: [e-mail]
ARPO's Phone#: [phone]
Date:
06/07/2023
.waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: David Rives [�
AY 0 0
Address of Property: 128 Forest Ave Manteo NC
Mailing Address of Owner:
Owner's email: jdriyes6(dwmail com Owner's Phone#: [phone]
Agent's Name:Jillian Kalis / Shane Clark Construction 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
.... .�._ ,....,..
I DO NOT have objections to this proposal. I DO have objections to this proposal.
w
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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. 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
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Alvah H Jr Ward
Mailing Address of ARPO: P O Box 266 Manteo NC 27954
ARPO's email: a &c ri (D C ARPO's Phone#: ZS 2- 473 - Z �%
Date: S J k s *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
SrK /3a1

Jillian Kalis
Shane Clark Construction
607 Indian Dr.
Kill Devil Hills, NC 27948
Certified Mail — Return Receipt Requested
4/24/23
Alvah H Ward JR
PO BOX 266
Manteo, NC 27954
Dear Mr. Ward,
REC I,jED
MAY 0 8 1013
®CM -EC
David Rives is applying for a CAMA General Permit for his property located at 128 Forest Ave.
in Manteo, North Carolina. The specifics of the proposed work are as followed:
- 60 ft. x 5 ft. pier with a 16 ft.x 16 ft. gazebo C zS<-
- Step down, drop platform on the southside of the pier
- Vanishing stairs off of bulkhead into the water
- New ground deck framed off of current bulkhead
- Repair bulkhead
As the adjacent riparian property owner to the aforementioned project, I am required to notify
you of the development in order to give you the opportunity to comment on the project. Please
review the attached permit application and drawings.
Should you have any objections to this proposal, please send your written comments to:
Yvonne Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-264-3901, ext. 237
401 S. Griffin St., Ste 300
Elizabeth City, NC 27909
within 10 days of your receipt of this notice.

Such comments will be considered by the Department in reaching a final decision on the
application. No comment within 10 days of your receipt of this notice will be considered as no
objection. If you have any questions on this project, please call me at 740-359-7132, or e-mail
me at j 11 < nkali ;' sfrzrieclarl<cai7:; "I .
Sincerely,
Jillian Kalis
Office Manager

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30AVOMr1, ❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
�C Nv 89756 A B C D
Previous permit
Date previous permit issued
0 New [-]Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the 44State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
f 1
I SA NCAC 1 r''
/ '�
❑ Rules attached.
0 -Qeneral Permit Rules at
the following
link: www.deq.nc.goy/CAMArules
Applicant Name
v ck vr tl
q
K ✓ s .
available
Authorized Agent N « n e;
�- j <* f
is
Address i / .5
c, K. f-
Or ) V'
Project Location (County):�=—
City C=i (o_
;t ox State
Via, zip ?. `/-5-5
Street Address/State Road/Lot#(s)
.S .L
/�U j / 19
Phone # ( J$1,
. L „ (
I %Z
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A v
Email ' rJ- T- r
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,
Subdivision r f 9 n v-
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City M ,, n (- < ^,
zip
Affected ❑ CW
MEW
❑ PTA ❑ ES ❑ PTS
Adj. Wtr. Body
AEC(s): ❑ OEA
❑ IHA
❑ UW ❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body
S
ORW: yes/no
PNA: yes/no
Type of Project/ Activity
r n (Scale: N l 7>)
Shoreline Length
Access Length-
-)_
_
Pier (dock) length'—'-
FixedPlatform(s) !
{f-�
Floating Platform(s)-
�..--
F
r
1
I_
_
,
_
_�_
r..
_—
_
Finger pier(s)
_—
L—
—�——�
—
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�
_
—AU)
—
Total Platform area
Groin length/p
Bulkhead/ Riprap length '
Avg distance offshore
Breakwater/Sill
Max distance/ length`
Basin, channel
Cubic yards `
Boat ramp
Boathouse/ Boatlift'
Beach Bulldozing .-
Other.t
SAV observed:
yes no I
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
i
Application Feels) Check #/Money Order Issuing Date Expiration Date

AMA ❑DREDGE & FILL
GENERAL PERMIT
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
N° 89756 B
Previous permit
Date previous permit issued
ylt7
As authorized by the.Slate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 7 I ' I l' 2- a ❑ Rules attached. Pl�qzneral Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name L
0. 14
9 Syct sf
Authorized Agent .SA 0. A n_.
C. I *--e
K C n n ST rux-AsJ^
Address ! IS Lake
ri eL44..
0 ri
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Project Location (County): ID
c.r4L—
City G-5 l a 4-Aa.
State
dA
zip Z / SS %
Street Adclrress/State Road/Lot #(s)
S ��70
1 , #04
Phone # ( ) % Z I
-%.C, S (
12 8 �� i'e.S
AV Q..
1 ��—
Email ar't✓a.s
4D or M
o-; 1, c N ,
Subdivision V'Ip !`
Po'r-k
City /h s A T'RA
ZIP
Affected ❑ CW
NSW
® PTA
❑ Es ❑ PTS
Adj. Wtr. Body o � n c
�-So
(na an/unk)
AEC(s): ❑OEA
❑IHA
❑UW
❑SPIMA ❑PWS
Closest Maj. Wtr. Body /ROq/f.p k4-
SQcA 4
ORW: ves/ndI PNA:
of
Shoreline Length = r7'2
Access Length T v
Pier (dock) length
Fixed PlafformisI
I _,, Im MOO/ 1J1S F
44eeNnffPlafformis') /.o"JLti✓ �— — Ls
14,YFinger pier(s)Total Platform areaGroin length/# �
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
_
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
r —
Other b
L ad, e.4
b 7v
—1 Kt
SAV observed:
yes no ,
Moratorium
D
e no
Site Photos:
no
Riparian Waiver Attached:
yes
A building permit/zoning permit may be required by:
Permit Conditions
a <� 2S.5 0
I�yb
'r
en
f
° a
N
4-
_
P A
l �
2S
To !ie /l,�phl
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(Scale: N-15)
-17
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
,'}l t lC c Q rrncrrr I.C.`JVywt, I WJC..T_ Arz"lX'Z
pnTt+bRi2kT/�� TI-lir + �4/1E'CJ, LOB-YkL. pEJ2mzT ❑See additional notes/conditions on back
o FF J c E/2, Ca rfrJRcc SAdRNn 0 AJcwOEJ( 2S2-475-s'S49
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)1C
� /OnA2 C-0.r V�(-
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
�.
Signature "Please read compliance statement on back of permit" Signature
oo, " / I V(a (a /t'5A-3
Application Feels) Check #/Money Order Issuing Date Expi ation Date

Carver, Yvonne
From: Carver, Yvonne
Sent: Thursday, June 15, 2023 10:05 AM
To: Jillian Kalis
Subject: Rives GP/Receipt
Attachments: Rives GP89756 061523.pdf; Shane Clark receipt for Rives & other pending project.pdf
Jillian,
A copy of general permit (GP) number 89756 issued for Rives' pier project in Manteo is attached for
your review and signature.
Also attached is a copy of your receipt for the associated permit fees and open balance for next
project(s).
To validate this permit, please address the following:
1. print and sign the permit on the bottom left-hand corner below your printed name,
2. initial where indicated on the bottom right of the permit,
3. scan and send a signed copy of the GP back to me.
No work can be initiated until after we receive the signed copy. If you have any questions regarding
this correspondence, please don't hesitate to contact me.
Thank you.
V"nne
Yvonne B. Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-264-3901, ext. 237
Please note that my email address has changed to: yvonne.carver(cDdeq.nc.pov
401 S. Griffin St., Ste 300
Elizabeth City, NC 27909
ME Q-5i
Opn�tment of Emkonmenlel Owli�
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.

RECEIVED
SEP 1 1 2023
ADJACENT RIPARUNP OPERTY OYIMlR RO11y1CAtIVNIWAWtN rVlt�y-`k`fv
GERIIEIEU MAR R�$N,��6R+1 R'OU[�j(Qa11ARD OFIIVERY IED
(lop Won to ba oanpbled by ownel of IheN egerR) NO J J VJ
Namsa Plnpar{y Ormp_.peyl�[;(Ye5_—...____.._.__._.___..__....____�.�..._...,.:.,,.__.�/♦ _/�
AOsearWPrrywry. _J2gJ:0[aHAvu Maryla0. H�__-�.w__..,.- _._
maapAareaa a ownr. Tl_��w1+FiGI.vMl7a..YA24.11i�..----...._.
c>Mera«,yr-.)4riresk84ulRlg.wRl___owrwr:Pwn�1 _yQg.�Z1��G21__._.
Alt[nl'a Nana laal lSelp l.`.lR10a SS1i11kS;u1Ol0Uwrl Aglml Phmw11A4Ya2lli2 —,.
apRR. Emw_-pWatkR§sle�arRTRecIaAf:D1lS10CtiDR.arV ......--.. _. -. --
ADJACENT RIPARIAN PROPERLY OWNER'S CER IV tCATION
1@1dlVPLCDnbtl to Or.L4®11!fRf9�J119 �-a�liG42Lf0(NLIy VR[!!f:ll
Io.,of e$qk ub [rrin proparry aP .1WbNwlo Xt ndl.Ij 1px,I,el% The irxaIh"al#ppo plbWs
parrwl has OeKnNed b rrq as iMwn im the a74xneA draw ) Ihx de.t%opa'Onl Ilwy Ma faopua" A
4vsLf&IARai„XAD 91RICerIanATolsl4a PIW�RI wdh lCn 7rIW
4, I IY.1 NOI ha.e obredrPna In llas pop05al _. _. I UV l wa nt�,ar!0rrs 101ho proPO[al
11 you Irara afr)affifMu 10 wAsl is bralp'pa/»aW, you meal nOldy the N C Orrfibn or COaslal
me'asomanl faCM) on wNNno w)aA1n to days of fmol of INA "Ike CrMrosPPndtncB sh0uhl Oa
mwlad to/ol S. prw7n 3f. Sb. 700. (wfabNA Cyfy, NC, 1T90y OCN npr-$IIoM Ms can /1[o be
confaf ted of (M) 261J901- No 1a4100f1sa Is eanirr and the acme as na op}arbn it you have pawn
aadled py Coo~ Had,
WAIVER SECTION
I KR1rrYlNYI lhil Miy pfU(USMI rel, tNICr. t100(I(YJ {NIt15f Y. [tHl ranP, INIMY/abl. s w+tln M r fts, M6P_ eA,
H'sfr au[1 be raw bacl. # newie�nr tlrsLl11f.0 a /5' IfOm l area of a un nya
I lhs rpm rrol apply 70 b VR w) [ ar nryaP re'M7mMIjT` Yfar w'r . ,. n
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OR.
I QO nVl wM Iowa" me 1� pa76nrA rugwelrwnl ImAul the IAaN'.J _. _-_..,.. -. _
RgnNwa w Adexwt Hpw #n Ih Vperk Ownm
T[p4alPnn110nameo1ARPO LIWU*AlptlN_.___"'.VVV_.""����4a
Valhny AAJlu[[aIARPa,.. 213U3.I1ru1Wl4Uu4Aei CWYWddL.lfn nasY ___.._
ARPO'sunAg _.. - .. _. _. __ ARPO's Phonel:,,.,_,,,,,_, ...._—..___..
Is vaNd Wr up to orle Year hero ARPO's Slonslydr'
Ruvrsai July 2021

N.C. DIVISION OF COASTAL MANAGEMENT 11
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FOP01-- � gq 7 �
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY C— 7 Ff
(Top portion to be completed by owner or their agent) MAY 0 8 7023
Name of Property Owner: David Rives C ---DCM
Vt APEr
Address of Property: 128 � ant . NC
le
Mailing Address of Owner: 115 Lakeridge Dr Gretna VA 24557
Owner's email: 'drives60—cimail.com Owner's Phone#: [phone]
Agent's Name: illian Kalis,/ Shang Clark Constn ction Agent Phone#: [phone]
Agent's Email: fiIliankalisCa shaneclarkconstruction.or
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
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 noury me rv.k. Umbow, v. a Vaa,-,
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. 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 L biQlCeS(�)M J?r 9/1 /2023
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: Charles Brown
Mailing Address of ARPO: //23223 Hanging Tree Ra rtr VA 23837
ARPO's email: C �0.�� Q br'o 9 p M S4, AA P- 's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
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