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HomeMy WebLinkAbout92537C - Suits, Eddie CAMA C I DREDGE & FILL ° n ` . ` .'-,, A B 2? D GENERAL PERMIT Previous permit _ �'• j Date previous permit issued _--- f "`` ''' 1New Modification .;+t�";,�:-:;� [_-] LI Complete Reissue []Partial Reissue As authorized by the jState of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to: I SA NCAC__ 1"i'444;.__fV,}____ __-_ —_____• U Rules attached. L-] General Permit Rules available at the following link:www.dea.nc.Qov/CAMArules Applicant Name-.re __�� —___._____—.__ Authorized Agent_-t''U'lett_ni L.t i_ y'.�Q,.�' Address__,' • .______ Project Location(County): I_ I ( tY):__.-a �.[---�.__._._ City._ _ State ---ZIP (` L Street Address/State Road/Lot s Phone# ) j 3 ,�} P Email ."---"'' City- 1l �� G L!_ir1._.... -- - --- ZIP G Affected L CW EW PTA ES L]PTS Adj.Wtr.Body._] __ _ -_.____.______ na anlunk) AEC(s): 00EA 0IHA L UW 0 SPIMA ❑PWS Closest Maj.Wtr.Body €A.,I ) ji� ___...,_...._____- _. ORW:yese) PNAejno Type of Project/Activity c X , , ` . . �� +' (Scaie:fi_Jj J) Shoreline Length_,j1T____-u. _. Access Length �- v .- Pier(dock)length / y 1N)X,u !46''X'5 /FixedPlatform �XP- CO-SA- l a 11 Ylt CL . .-- �p l�L Floating Platform(s) `'- W,h_I" __ Or lJt `,t Finger iers) �.�/ =,_ ail (9 10 Oi Iry /-1 ..&..> 1, Total Platform area_ -- Groin length/q —___— I • Bulkhead/Riprap length ��"" 4 hiv�!kill_ Avg distance offshore:�� — _ 7 i � ) Breakwater/Sill I�A. .Max distance/IengtlT '' /�r ���+.C?% ► etiy: V Basin,channel ) �� ��� Cubic yards r 0, 10 '� Bo - )]t/f+� \__. L :oathou• ;•atilt# ISI© )0- /( ))1'41 '� Beach Bulldozing :• • lair)/ A.i+ Other e eL1.,a SAV observed: yes oa Moratorium: n/a yes o 0rj I9J/ D ' , Site Photos: r ! Riparian Waiver Attached: es • A building permit/zo ii a I edtf : / CU 0 TAR/PAM/NEUSE/BUFFER(circle one) Permit Co ditions_ .. "Iltiald.----- l . _ :iii .a. !� _ Vil __ El See note on back regarding River Basin rules fst-S , ,. Li M See additional notes/conditions on back I AM AW E OF ST TUTESL£RC RUL AND COS!TIONS THAT APPLY TO THIS PROJECT AND R VIEWED COMPLIA E` TEM T. (Please Initial) ! �, �I*'. A n r pplicant PRINTED Name Permit Officer's P(N D Name — A.✓ sr.T,- 74 V nature ' lease read statement on back of permit•` Si nature Application Fee(s) / Check ft/Money Order Issuing Date Expiration Date o��"mr4, '� 1CAMA I DREDGE & FILL No 92537 A B �i D GENERAL PERMIT Date previous permit issued ---- ritNew (1 Modification Complete Reissue El Partial Reissue Previous permit . - 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: tt, 15A NCAC 1 ' 1 az 0 n Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules w Applicant Name " Authorized Agent 4 110E t4 { 1 K l t .Q l P h/ t Address • Project Location(County): elk - City ) State ZIP Street Address/State �Lot (s)� PetPhone# J` Email • �� Subdiv' ' n City ZIP Affected ❑cw r5,4 EW NPTA n ES ❑PTS Adj.Wtr.Body e unk) AEC(s): ❑OEA n IHA UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body n k,U k,41—... ORW:yese) PNA es no �1JLVV Type of Project/Activity (?.�Q/�,1 Cl/A1,-M,C)0CC ? \) fi�f'�l�j(l' �' J c t t 1!pVe4-D f 1 jScale//�3On Shoreline Length 11'T Access Length \J.,'.- Q CLA ^ /t_ t f A Pier(dock)length ma.��/_�lyyu 11H6']°51" Fixed Platform(s) 1►+�cC11[JI�lfl 1j0� Floating Platform(s) ' ( I----f- - ' ' °11: 't i 1 I f % �`l� I _ 0 ][��/ Finger fier s) ., ��I_ i!V JS 1dV� Total Platform area y 1 Groin length/# a ( . Bulkhead/Riprap length —' a i A e Avg distance offshore �_ .. .._.....__._. ,.'� 0:1# y-- Breakwater/Sill 1 IA Ak �� ,.: - . , _ Max distance/length`` 1 ! {� Basin,channel _ Cubic yards } Y Bo. —. * --- /P/"0- b) :oathou Boatli v ' _ ©•x V Beach Bulldozing . .4 i t I .a I ......1.)601, Other i i ilk SAV observed: yes ,11 r Moratorium: n/a yes j �� Site Photos: I I . j } Riparian Waiver Attached: , uJ I i r I A building permit/zo p-Nr� - '- eq(I'-. tt : Permit Co ditions (suc ( *al 1,n ,/(f�J, A f4 ❑TAR/PAM/NEUSE/BUFFER(circle one) NW) ^'"/` _ [1]Zajafi= See note on back regarding River Basin rules TO t C5f ci---- - ❑ See additional notes/conditions on back I AM AWARE OF ST TUTES,cRC RUL AND �COO/ ITIONS THAT APPLY TO THIS PROJECT AND R VIEWED COMPLIA rE. T. (Please Initial) wig"' j_I .,01�.� ►' Agent or Applicant PRINTED Name Permit Officer';P 4 N D Name S' nature please read compliance statement on back of permit" Signal e 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: 252-247-3330 252-946-6481 (Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: 252-948-0478 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: 910-395-3964 (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 '''''`'''�ti. CAMA DREDGE & FILL No 92537 A B & D Liii GENERAL PERMIT Preepr permit Date previous permit issued New Modification Complete Reissue 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: 15A NCAC Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules Applicant Name -1(1i. . Is Authorized Agent , , P. Address (,�(\Q(t l Project Location(County): 4 i City ,�/'',�,(-, State ZIP '''l-I ( i Street Address/State Road/Lot#(s) Phone#(,Q).W13 '^! P'� :r Email Subdivision City ZIP Affected n cW El EW n PTA n ES PTS Adj.Wtr.Body »- -•f . . (nat/man/unk) AEC(s): OEA IHA UW I SPIMA n PWS Closest Maj.Wtr.Body 1 VW i P1\.` ORW:yes/no PNA:yes/no L, 41 .0 1 Type of Project/Activity n ( N. �.S'\.C�0,.'�r'0 (L Vim) ti six v ,r "")P r+ 111 q; " 41 .4/; ��'i w(� -) (Scale f/!3/) Shoreline Length Access Length j arq.. .. . ..,. .. .. Pier(dock)length ', � -\ ( ._. ( I}'� f► et/te /0;6"a X(fr Fixed Platform(s) I Floating Platform(s) f , Finger pier(s) —I AG.' i' � !/0t )01 1QAQ{k 170 ' 4. Total Platform area 7.M _ - , Groin length/# "---' 1 ) / AI Bulkhead/Riprap length "" f — �/I �t_-- --- . l to,,. ...._... Avg distance offshore _-� ...... -_._..__ i ..----.. -._. ...... ..._ ,� ; -..... ........ ...... .... ........_....... Breakwater/Sill r " ' Max distance/length `� r�� 1 6. ' Basin,channel 1 1 /' Cubic yards - _. _._... . '_.... _._... Boat ramp /P Boathouse/Boatll 0'x I�' Beach Bulldozing I r r Other ?' p SAV observed: yes no — �""" ( ' Moratorium: n/a yes no 1 ' (4461 N P' — ' Site Photos: yes no . ,--- Riparian Waiver Attached: yes no i , A building permit/zo i i)'iehmit maybe required by: n TAR/PAM/NEUSE/BUFFER(circle one) Permit Conditions Fes ii ,�l . 4 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) V(_s' 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: 252-247-3330 252-946-6481 (Serves: Carteret,Craven—south of the Neuse River,Onslow Fax: 252-948-0478 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:910-395-3964 (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 ��F`°'r'� CAMA DREDGE & FILL No 92537 ABC D o , GENERAL PERMIT Previous permit Date previous permit issued I !New Modification 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: ISA NCAC I I Rules attached. 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 /t r \' Affected CW I I EW PTA ES PTS Adj.Wtr.Body 4„ k L,‘�., (nat/man/unk) 1.. AEC(s): I IDEA IHA UW SPIMA PWS Closest Maj.Wtr.Body �. t� r,` r- ORW:yes/no PNA:yes/no Type of Project/Activity ' ' , . ' �,, . ? ( ' (Scale:- ?) Shoreline Length r Access Length I E I J�.. _ t A ...,....... Pier(dock)length i� x�'` >•11-1 t i ri 1� iOt. _ 1 ) c. t=1r �y r�.j f '.¢ `� . Fixed Platform(s) 1 i' t+r tt Floating Platform(s) '" - _`t t c E 4� {C) It 4 ; .. 4/ yy Finger pier(s) � � t , : - --i- --1-• 4 Total Platform area slcsTi r , 1 Groin length/# --- . , j . Bulkhead/Riprap length - Y____-+__ . I � { Avg distance offshore �i ,`it _._...._....._.__-,,1 yip! 157, ki r.. Breakwater/Sill �ha L�`` Tom. Max distance/length---.-.. 1 ! - \t ��� I, si I.,,i 0.17 Basin,channel J Cubic yards JJ ri1 _.. --�-. - _ _...----. -.___ Boat ramp_ 1 is ,tl 1' 1.-__ . _. r�� i . Boathouse/Boatlift -`~ I'.r X j t i r i /(iVt , t, Beach Bulldozing '1 ' 14 ' II ( Other I �...�_....._..-.-..I..I,.,�,�. SAV observed: yes no ,�•��� --..� A ' . Moratorium: n/a yes no ' ' ' 01 -.)!J' t)- T Site Photos: yes no ! - Riparian Waiver Attached: es no I I I 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 riSee 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:252-247-3330 252-946-6481 (Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: 252-948-0478 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:910-395-3964 (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 Styron, Heather M. From: Sherry Tipton <ennettmarineconstruction@gmail.com> Sent: Wednesday, October 18, 2023 4:06 PM To: Styron, Heather M.; Sherry Tipton Subject: [External] 134 Cando Dr. Attachments: Suits CAMA Docs.pdf CAUTION:External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message button located on your Outlook menu bar on the Home tab. Heather Please see attached,Sherry will be sending$200.00 Check Thanks Parris 1 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: t 4 d i c S(,( I -¢'S Mailing Address: /3 41 ( z1 v)d o Roc,d 5'2ead s Ferr?, NC- aj 460 Phone Number: 534- 14(1- a/51 Email Address: e SL Ji5( cminizioica 60141 I certify that I have authorized E1)1)e Nctri11 e (onSf rq c/a/1, LL C , Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: tO'X 5 'pt cr; la/xao l cbclf W/ I 'xl ' roof A eogi Buses w/Le.f 5 4' 'ngcr er_ Demo txi5k9 5 c-mt res v- k t w Ott ✓ at my property located at /8'/ c4 l)d o i2d Xi9cadS c r/y in (Li /t (1) County. I furthermore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signature C Print or Type Name Title / I fC 1013 Date This certification is valid through I I • N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completedl by owner or their agent) Name of Property Owner: E-Cid 1 J e U45 Address of Property: /34 C/lT) de) Rd t5I2cad 5 r r 17 Al c pm c Mailing Address of Owner: 5(1 rf - Owner's email: e$L,u 45f esp/A T M i✓.LC Owner's Phone#: 33 ' l�c1 - /53 Agent's Name: Enn al Marine Ci���i�jl-I6 Clpgent Phone#: 'I1 i) ' L o l-j715- Agent's Email: E i)ld it ri"l(irl C)c:CL)n -f r jC i bn 6 incu]. C�ft) 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 kt' permit has described to me, as shown on the attached drawing, the development they are proposing. A 9\1 description 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. 1 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 y LlUJr (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign U� 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) \r\t. Signature of Adjacent Riparian Property Owner S) Cplm6 FAO Typed/Printed name of ARPO: s h,n� M Z `t C i , �1 a J Mailing Address of ARPO:/2-7 CqiAdl RV `,IV2_,Q re-Kfr y 'vC/ e ARPO's email: cj !�[')ram{` 6'� �` Ac PR O's Ph n one#: � ` 2�Date:/0'-/R-2-)G.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: E dd 1 e Sa J 1 Address of Property: 1 34 C.l�fl d o Rcl 54cadi' fcrr Y NC AF7&4 Mailing Address of Owner: Sam e Owner's email: esLyf 5( ).&1r1I l4/l•c0 Owner's Phone#: 334- '49- o111✓ Agent's Name: Gno None ( 1.14 n Agent Phone#: Agent's Email: ne,aW1 TUC*OV) i 917tcul .Gom 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 �n l 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. Dn (A1&I1 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 Dif I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or cct A V 1 groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me J at (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign (,pi' the appropriate blank below.) I DO wish to waive some/all of the 15'setback./Y� 4 � Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank)* /// � 1_e Signature of Adjacent Riparian Property Owner: p' %raw"/c' 01‘ 1) N Typed/Printed name of ARPO: t `444,- rn` S" f J Mailing Address of ARPO: 2 Z� <��' � �'^e 57-61 c Fs r1 ARPO's email: ARPO's Phone#: '7/a' 3 8 j'. 09 9? �0 eiL Date: `' /3 "3 *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 , • • . . • • 4 _f al . : f _ < ', . ; : : •• p st&Ai-P-44s __JOY4( f.. 4/. .5 _ _... --- • - — .... # - - - - - - r , ,:.,, , ,. . • - 1-7--, Lr--, ____ • ..._:. '' .113— 1---.. —'—': --t-- '''----.i ; .'• i f.... -----;,,—...--1 —..—6--- .'iv 11•.- •-•• .::.- • !.. : l '. • 41k • f-- : .1''..—C 1•1 '. • , • 6i .. Iii i i! ' . 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