89982A - Hatchell (MOD)

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�OCAIVIA ® ®RIDGE & FILL NU 89982 AU B C D
GENERAL PERMIT Previous permit
t Date previous permit issued
�Z]New 9odiffcatio�y Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commlmlon in an area of environmental concern pursuant to:
I SA NCAC tl�, Y / O`r Rules attached. 'General Permit Rules available at the following link: yAvwdeq nc gov/CAMAn Ion
Applicant Name Gwl a.b 'r (rWj.i 1-AKy % ,0,4<A%J
Address!A• `A o, d '� % el 8 `_')
sr\ city C.AEnt gN state N �' ZIP 2%qsw
Phone # (A) 'f 7 - 17 le
Email
Authorized Agent N it C"T k"9-45�3' WA 1VkoX1 na-
Project Location (County): Z) o..C4.
Street Address/State Road/Lot #(a) ey'r 9
1 of L rs. 1"^ A Lan¢
Subdivision .. S /Lti 1ls
City / Q.A':> ZIP 'Z.i 9 sue_
Affected ❑CW gjw ®PTA ES PTS Adj. Won Body aen'.. a7 eY,+ d!'ou - a mardunk)
AEC(s): ❑OEA EIIHA UW E]SPIMA PWS Closest Me). Wm. Body�oa F's.Sos ^
ORW: yes/Q PNA: yes/® i k�b
Type of Project/Activity C'oA 6 h.. (A I-M-15' X (a r A �(' „,•, _/.-� 2^" ,c 9_a� A
Shoreline
!15r CRC/nls F
Access Length_ R.bp AID 9Z e
Pier (dock) length )e 5 v
Fixed Platform(s)�+> %'?. q •9 /� T�./�'"'i'�corr �g-�'�
F e l.yi �4 l jr QSua.}-�)P�
�' �n � f rr'" • j7
i J k P
kn
.0 \ C4
Floating Platform(s)
Finger pler(s)
Total Platform area a
Groin length/U.
Bulkhead/ Rlprap length `
Avg distance offshore
Breakwater/Sill _
Max distance/length
Basin, channel
Cubicyards "
Boat ramp _
Goathous BoatllR J / aJ
Beach Builder ng
Other
SAV observed: _ yes no 1 {t,<-
Moratorium : n/a yes
Site Photos: yes �noQQ� C'S .1>.n S
Riparian Waiver Attached:�—
A building permit/zoning permit may beerrequL'red by: is :
Permit r.ndifi n A / / .S 9 U-caa S —
"Please read compliance statement on back
� �J o a ;t;1ea
Fees)
14/ -- Glta //
q d, TAWPAM/NEUSE/BUFFER(circle one)
See note on back regarding River Basin rules
en
See additional notes/conditions on back
(please I.M.9
Issuing Date Expiration Date
e_3

AMA ®DREDGE & FILL N° 89982 GB C D
GENERAL PERMIT Previous permit
Date previous permit issued
Z] 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 / n/T tl9-, ' Y / Y A� ❑ Rules attached. r4ffFGeneral Permit Rules available at the following link: www.deamc.gov/CAMArules
Applicant Name Gal b W(, r %A0.y kJo,-kk cu
Address )b f 7
City State N `' zip 2'7951
Phone#(=) q73
Email
Affected ❑cW
AEC(s): ❑ OEA
ORW: yes/9
Type of Project/
/ :nt
Shoreline Length
KEW ©PTA
❑IHA ❑UW
PNA: yes/0
s t'r
❑ ES ❑ PTs
❑SPIMA ❑PWS
Access Length 7 P,pfk AID BCC
Pier (dock) length ! D Ci )e (n �, /.1 j .9
ID
Fixed Platform(s) .Z v K 9L. O
Floating Platform(s) `
Finger piers)
Total Platform area r� .�
Groin length/ff J 2
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp 2
Boathous Boat ftft / .'�
Beach Bulldonng
Other
SAV observed: yes nd �
f
Moratorium: n/a yes
Site Photos: yes no
Riparian Waiver Attached: Yes 0 if r
A building permit/zoning permit may be requjred by:�
Permit
Agent or Applicant PRINTED Name
S
9
Signature -*Please read compliance statement on back of permit"
OC> _2oa ae�y SI(ol 4- S51'L
App ication Feels) Check h/Money Order
Authorized Agent N Z"f" ^� Rr/I M6x> A
Project Location (County): Str✓ I
Street Address/State Road/Lot #(s) a 9
2.z9 L Ia,.d Le- ^Q
Subdivision u 5 Lin 4 1 n �1
City /%� a-n'f-�� ZIP 2! 9 Si
Adj. Wtr. Body X oc<5J kt oi'��11''�oc..n�r.
Closest Mal. Wen Body OL 0. K o jtrt. Soul+
AI s (Scale: pJT� )
✓��� g l'?i�,>t (:fir LS*�c.;f �)S"�'
14a_ CIA-- l/
F
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
JD REVIEWED COMPLIANCE STATEMENT.
J
Perm�itzOfficer's PRINTE�---6.�'�
�D Name
S1 Tr) �'�
Issuing Date
(Please Initial) �'—
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
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven— north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover and Pender Counties)
Revised 6/01/2021

PPAMA E DREDGE & FILL N° 89982 ;A i B C ab
GENERAL PERMIT Previous permit
� Date previous permit issued
N)PNew []Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dea.nc eov/CAMArules
Applicant Name
Address
City ;
Phone # (_ )
Email `
State ZIP
Authorized Agent "_
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
/
Affected ❑ CW ❑ EW 0 PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑INA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:. )
<hnrelin Iun h
Access Length
ArY—
Pier (dock) length
Fixed Platform(s)
r
1
•.
-�.
�i
- -
Ik'
�
—
I_
Floating Platform(s)
I
Finger pier(s)
Total Platform area
Groin length/q -
Bulkhead/Riprap length
--
--.
._-
f
I_
t
I
-
Avg distance offshore
—
—
--�—
_---
_.i--
i
-
rt_—IIIL
--'
---�-
Breakwater/Sill—
i
�.
i
I�
_
I
T'
�
't
_y.
I_..
�_
T
Max distance/ length
Basin, channel
T
�__
-_
---
"+
—�
—1-
I
—�
T—
—
Cubicyards
I
C
I
I
Boat ramp
Boathouse/Boatlift
b
V`
I
I
I
i
\
y
'
�
��
.-'
Beach Bulldozing
Other
.I,
i
,.:j»....�
ate
�„
f [
_
—
—
x
,`
F--
SAV observed: yes no
Moratorium:
-
`T �`-,-j—
--------
n/a yes no
Site Photos: yes no
i
L
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**
Application Feels) Check #/Money Order
Signature
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 1-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden,.Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHnR17ATION FOR CAnIA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: pry nc ;
Phone Number:
Email Address:
I certify that I have authorized I \1 � -�i(t 1[�e
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:
at my property located at
in—LasF.-a—County.
L VI
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:
51gna u
Print or Type Narne
T/Ile
Date
This certification Is valid through ___ ___ _! i
Revised Mar .9016

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: f l' 121 ItV,L�h e 1'
Address of Property:
Mailing Address of Owner:
r1,+� ' 1 atiasq
Owner's email:' r Owner's Phone#: vc- a - `t ' J -rU ID to
Agent's Name: LtE�1Qrt ( Agent Phone#: and . �191 2Ra
Agent's
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owns'l
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
descriotion or drawing. wilb dipiRpelons.must be provided with thl Is
CCV .nJ( (,ram y, (t1f-r -*17 *210 a50grt*) t1S� bbn� 1. �
I DO NOT have objections o this proposal. DO have objections to`t is proposal.
If you have objections to what Is being Y / g 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 somelall of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank) /' k�
Signature of Adjacent Riparian Property Owner: _
TypediPrinted name of ARPO: /1<4 &y ho
Mailing Address of A/RPO: 3155 i9wtot �ar ©Nth i h r--W d gtaliw 2? 113
ARPO'semall: �+S(ifg(WDY�jtto.(A� ARPO'sPhone#: Pw`Y,23-f79T
Date: 7 Z(p`�_ j *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

r
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits,
1. Article Addressed to:
r1C �i r� fit t5"Clu
t111�1t�4hlc�t,�Vrl QL3i\3
9590 9402 7859 2234 0529 66
--. 2,_AI,tICIe Number O'rens/al /rom service label)
_7022 0410 Coon 5530 '793
P3 Form 3811, Juiy 202 Ps • 2ADO-itwa--
■ complete items t, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the tin,.,, . ; ,._
1�fix45 'j
9590 9402 7859 2234 0514 19
2. ANole Number @ansler/mm aeMde lebell
7022 0410 0000 5530 79
P3 Forth 3811, July 2020 PSN 7630-c20 nsgD00
X ❑ Agent
❑ Adore
B.�ReyeNed b=dff'W&d
C. Date of Deli
IINL
0. re delivery aItem 17 ❑ Yes
If YES, enterdelivery address below: p No
Cl Primly Mall Eames
Resldcted Nary
D Registered Mal"
O e&l.tered Mail Rntrlateo
witted Delivery
❑ elgnatwe c"kniationm
ev
ey Roinne ad Deovery
❑alprwl,ae connmwtwn
Restricted Datvery
Domestlo Return Receipt
..-�•�w,m newm ae"lpt

sOxNx —0
ro
ROAurtE 1. THIS SURVEY IS SUBECT TO ANY FACTS THAT MAY BE
SNrvS OISCLOSEO BY A FULL AND ACCURATE TIRE SEARCH.
2 AREA BY COORDINATE COINUTATION n x2FA II? S.F.
3. F.I.R.M. ZONE: AS SHO'AN
4. PIN NO.: 11 988117 10 3326
5. REGORGED REFERENCE: P.C. O. SL. SITE: D.B. 2214. PG. 154
G. MINIMUM BURDNG LINES (UK). IF SHOW NERECN ARE PER THE
CURRENT LOCAL ZONING REGWAlI0H5. OINER EETBACKS
MA,. HID/OR RESTRICTIONS MAY APPLY AND MUST BE V r ED
aOAR muw PRIOR TO CONSTRUCTION.
isANO 7. ELEVATIONS (NAND 1988).
o LMWwD 0 BUILD1NG = Is . ROANOKE SOUND
MST FLOOR . 21.8r •^• w i!
GARAGE SLAB a 18.35- •"• Q
Z 8. EXISTING LOT COVERAGE: 4.712 S.F.(17.59.) -' w w N<
9. DARE COUNTY ZONING, R-) 4 L5
%OBSERVED WATER ^ (.•- _�RH�O `ApIT.
LEEL (02/13/18) w W-
nu�oKaq ....\ . %a'...�...- 3 I O� RP -RAP
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y =;
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pFp FOTIME, It
LOT 7 I Yile�lA'
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LINE TABLE
LINE
lENG1N
BEARING
L1
12.54
N
33 4B
46
1-
L4
.79
4
L
88
A
9
LIVINEI
91.43
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(O.B. 2203. PO 325) Pl. - PROPERTY LINE
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AS -BUILT SURVEY FOR
CALEB J. HATCHELL &
WHITNEY T. HATCHELL
LOT 9 — DOUGH'S LANDING — ROANOKE ISLAND
NAGS HEAD TOWNSHIP — DARE COUNTY — NORTH CAROLINA
ED 50
_
,inch
�^
SEABOARD SURVEYING & PLANNING, INC. C-1536
--
=
1 50 (L.
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103E W. WOOD HILL DR., P.O. BOX 58, NAGS HEAD, NO 27959
TE:1e0e092 suRYEro u 10 I do P! ATTED 10 18 19 aTu
�,EL
OFFICE: [phone] FAX: [phone]
l SA e
µQ-j'i i.'Ke.
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0x13

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1.5•
NOTES:
I. THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY
BE
01SCLOSED BY A FULL AND ACCURATE TITLE SEARCH.
Z. AREA BY COONOATE COMPUTATION - Y2G,B82 S.F.
3. FJA.M. ZONE: AS SHO'M
4. PIN KO.: 11 985117 ID 3326
5. RECORDED REFERENCE: P.C. G. a. 386: D.B. 2214. P. 154
6. WNIMUN SUBWID MINES (MBLj. IF SHOMI HE
R
_
O'{ ARE Fa iHc
WRIE14T LOCAL ZONING REGULATIONS. OTHER SETBACKS
RID/OR RESiRCRONS MAY APPLY AND MUST BE SERPIEO
PRIOR TO CONSTRUCTION.
7. ELEVATIONS (HAVE) ISM).
HIGH GROUND 0 BUILDING = 18.4• ROANOKE SOUND
LOW GROUND 0 BUILOM = 158'
FIRST FLOOR = 21.87'
GARAGE SLAB = IB.35' •••
8. EXISTING LOT COVERAGE: 4,71 M" "
9. DARE COUNTY TORINO. R-I 14 L5
_•, 09SERVED WATER
••.• \V` —
�• I
Ell
A�t,.
LOT 7 I PLO,, i'tI.0 • t
LINE TABLE
LINE
LENGTH
BEARIN
LI
I2.1
-4 'A '
L2
34
L3
32.46
1. 1'
L4
.7
LS
4Ao
4 '
77.71
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49.09
LINTIE)91.48
Lq(m)92.71
1 11 '
LOT 8
a 11.
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P
' S' UTILITY & DR,U1I. EhIT. j
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5U
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SEP 6 2023
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(I
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AS -BUILT SURVEY FOR
CALEB J.
HATCHELL &
WHITNEY T. HATCHELL
LOT
9 — DOUGH'S LANDING — ROANOKE ISLAND
NAGS HEAD
TOWNSHIP — DARE COUNTY — NORTH CAROLINA
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SEABOARD SURVEYING & PLANNING, INC. C-1535
103E w. WOOD HILL DR., P.O. BOX 58, NAGS HEAD, NC 27959
OFFICE: [phone] FAX: [phone]
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j 0 Complete iterp9.'f, 2 'dnd S. A. 61gnat i, e' � � RECEIVED
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■ Print your fta01B liaNdOress on the reverse X L ❑ Agent
so that we ca0-retum the card to you. ❑ Addressee S E p 0 6 2023
■ Attach this card to the back of the maiipiece, S• R; a ed qy nted N ) C. Data of Dellvery
or on the fronttf space permits. '•
1. Article Mdd sod to: D. Is delivery ad ress ddf from item 1? ❑ Yes n N [_ /^.
't'j„���yy /�� _46 � mot_ . FF If YES, enter delivery a ress below: ❑ No li V I C.,. l,p
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❑ Adult Signature Rnuleled Delivery ❑ Registered Mail Restricted
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9590 9402 7882 2234 2333 32 D certified Mall Restricted Delivery ❑ signature oordim ati ma /'
2. ArtICIB Number ❑ Collect on Delivery ❑ signature CaMirmaHon
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7022 3330 0001 7645 3303
Mall Restricted Delivery
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PS Form 3811, July 2020 PSN-1530-02.000-9033 Domestic Return Receipt
' ■ complete items 1, R'aitd 3. A. Sig afore
■ Print your name and address on the reverse X 0
so that wa`can rettlm4he card to you. ❑ Ad
■ Attach thla card to the -back of the mailplece, e. R - elved by (Pr/ ame) D. Dee of I
or on the front If space permits. ,3
1, Article Addressed to: - D. Is delivery, address different from aim 17 ❑
I l Io t\ow Ca,` _- Lt C. If YES, enter delivery address below: [3 No
PO 1220. 'AS
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❑ P lority Mall Express®
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❑ collect on Delivery Restricted Delivery
Residcled Delivery
7022 3330 0001 7645 3310
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PS Form 3811, July 2020 PSN 7930-112 000-8053
Domestic Return Receipt

::�C3
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be
Name of Property Owner:
Address of Property:
Mailing Address of Owner:
Owners email:
Agent's Name: LIC-. na n j
Agent's Emaili uA i L (� life n-io m C
by owner or their agent)
,tsi�iL r QSt f
Owner's Phone#: l^� �L� ty" t p C(P
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be complated by the Adjacent Pronertv 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
to this
nS gar)(XA- 11-4 OVe"
ions to this proposal.
If you have objections to what is being proposed, you must nomy we nr.o. urvrs,on or coasrar
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 riorap revetmentsl. (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- ��`)tq� !//{%)_
I DO NOT wish to waive the 15' setback requirement (initial the blank) —
Signature of Adjacent Riparian Property/Owner:
/ 4
Typed/Printed name of ARPO: 44
Mailing Address of ARPO: &CIS is f llh 4 A td It) - Mjr i, VO Z3f (a
ARPO'semail: tt�ry(wrocM1.(zbM ARPO'sPhone#: spy-y237S�
Date: *waiver is valid for up to one year from ARPO's Signature`
Revised August 2022