87070A - Swimme, Mark and Teresa

A(Omr", MCAMA ❑ DREDGE & FILL N° 87070 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
® New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal ResourcesCommission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. 0 General Permit Rules available at the following link: www.de .nc.gov/CAMArules
Applicant Name _
Address
City -
Phone # (_ )
State ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
ngth
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
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(Scale: )
Access Length
Pier (dock) length
Fixed Platform(s)
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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
Application Feels) Check N/Money Order Issuing Date Expiration Dat[

N.G. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
�:.FRTCw`tEC+tuir�ET 1��CCIP? REQU.tESTFD or HftN,�'.�c�„1�,IYE£{Y
(Top portion to to eMPIetod by owner or their agent) pp--
M1turrc cT Prgxarty Cwrr r: ;°ss wf�. a � ,a.."rtr�ti,+'� .mi.,a lny.3c;_' R EC F`[�'" gp " VE D
Address 44 Property: ^ S ' „ c.-� 4A14 OCT 3 9 2023
bbari;uv2.4tkirbsxv'OwJ1ar ' `�' •. F.n `. k`i+'" C',i, ,+„t.. O"?�fc-t //'����ryry
DCMOwner a ema=t-1 w{ram^ � SW i kmt'wr f, :�-; ctS Z s Phe-)e#. -957S 3 `j '�- 22 j`�
ArJeni'& Nan)A[ „I �E.Lk . 5t, ae,Yk-_-- Aticr. Pnono#. t
Agtenfs limit Y �Aias, ".i", .... SAL it &''..L, Curd ••.^ : r n.•
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Rpttom gqM- on to be completed by the Adtaaont Prooc„r„�gn . u ;
I haeseby c enify ffial i cane` v'oCtntY adjacut;i to tt1G ahove'v4crcrrrwd prollorty. Tie w4tvktual appiyinif `or this
pomd: has doscrlbed to me, as shown or Itw attached drt-M-q. the demiopmen, they are pr000Ving. A
k cr' lion or dravhna wilts rhtra>n,`+i_. vet UO.tKCYs'i� witq;h- .
i DO NOT Hair cb}ccaotls to fds proposaL 100 gave objec:iwns to this xoposat_
it yell Rave objucfrona to what is haing propose ,you rnu8f »ot the N,G, t?hrAsMn of Cnasta
Managamom (bC* in writing within 10 days of mcaipf of this notice. Co"ospoodance shored he
nnaikd to 401 S. Griffin St, Ste 300, Elizabeth City, NC, 27909. DCV represenfolivas can also ba
contacted of (262) 264-41901. No rosponse Is considered the same as no WLction If you have been
notified by Certified Mail.
WAIVER SECTION (Chpgsp on. NS.n>a
I du 6ownnd tfaat nay ptoioud pier, dock, mcocng p44V�, txrat minp, txevk:watw. t wrthrwvt, lift or
firoh ruled tm At back a rrimmmi .";tame W. I5* `rom my area of mpmion uniuua waived try me
(1hip f„rorti rue a{° la tr ak�ea or nrx ap ev_ein r�s}. fit yrd. M%h -o waive y0s must sign
t" APPrOp(MIA b44n2 baICY',}
I DO tiwh is iYeve sometaitof the SS' soitraa
Sigradwo al Adj; avol aria r'mperfy 0-tnar
-OR-
I DO NOT wtsh td txaive itto T3' aMback nxittiwmi milli! the blank)
Signature of Adjacent Riparian Property Owner:
n
TypadiPrintad name of ARPO: , :xn 44 . H G.�k
Mailing Address of ARPO: 6 t
ARPO's
Data: t ` $'_..._,'waiver is valid for up to one year from ARPO's Signature`
RovisodAugust 2022

i
N.C. DIVISION OF COASTAL MANAGEMENT RECEIVE
E
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY OCT 3 12023
(Top portion to be completed by owner or their agent) (�
Name of Property Owner: MA✓Gtc a Sr4c 2aS�- S�1MMl� ®C -/�yq�—E®"°
Address of Properly: 101 - A-4441-A i<_ :1i111'-1
Melling Address of Owner: Nc- 279 d I
Owner's email: r AA5..e Sw i Me w✓i Out �5wner's Phonelt: � .2 3 �% Fly `i 3
Agent's Name: NWRrE $tNin.nrc Agent Phone#; 1�z. 33t3 �iL{N
Agent's Emall: JVla��f o> y w/ MMG GAG! i6A a n
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own properly adjacent to the above referenced properly, The Individual applying for [his
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.
DO NOT have objections to this proposal. I DO have objections to this proposal.
Managetnent (OCM) in writing within 10 days of recelpt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste, 300, Elizabeth City, NO, 27909. DCM representatives can also be
contacted at [phone], No response Is considered the same as no objection If you have been
notified by Cortilled 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 rtprap 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- n
i
i DO NOT wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian
TypedlPrinted name of ARPO:
Mailing Address of ARPO;t
`
ARPO's email :t x nac,>� C' i ��- ARPO PhoneB:
Date; / L i. �/ _ 7 *waiver Is valid for up to one year from ARPO's Signature*
Revised August 2022

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
LAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (1 SA
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mall return
receipts (showing delivery of notice) are needed,
The purpose of this notice is to make adjacent riparian properly'oviners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DOM an opportunity to consider these commentslebjactlons before a permit decision Is made.
"Permission` of adjacent property owners Is not necessarily regulrod for DOM to issue a permit; however,
permission must be obtained'for certain types of proposed devolopmentsif they fell within a 15' setback area
along the riparian access area of the adjacent property, as determined solely by DOM, It Is in the applicant's
best Interest to provide comprehensive and accurate notice so that any concarns or objections can be
resolved early In the permit review process. in addition, If the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who Is an Adjacent Riparian Property Owner?
What Is Adjacent? (Note: DOM reads this broadly to ensure comment byriot uglily impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that Is connected to coastal waters and
can support some forth of navigation, even a kayak or canoe, Including a common canal system
or a manmade basin.
• Easement holders? Yos, If the easement could be Impacted by the proposed development.
• StreelsiRoads? Only it the street/road could be impacted by the proposed development. This
might include street -ands which might be used for parking and beach access.
• Holders of recognized submerged lands claims/sheWieh franchises.
What Is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high ttde? If there Is a
question about whether an adjacent property Is considered "riparlan," please reach out to DOM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or In the water.
WhoANhat is a Property Owner?
For private individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc, or LLC, please send notice to the person listed as the registered agent on the NO Secretary of
Slate's Corporations Look Up site: ittt)s../Iwww.sosnc.gov/searchlindex/`o--prg For Condominiums or
neighborhoods with an owners' association (HOAIPOA), send notice to the association (which Is usually a
corporation, for which you send notice to Its registered agent).
What is Notice, and how do I ensure It Is received?
• You can meet with your adjacent properly owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return It to DOM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return It to
DCM (consider providing them with a stamped envelope); OR
a You can mall this form by USPS Certified Mall, return receipt requested (the Green Card). if you
choose tills option, you must provide either the signed & returned green card OR track the
cortlfied mall package number on USPS.GOV's online tracking system, and provide the tracking
print -cut as proof of delivery to DOM
If you have any questions about this process, please reach out to DCM Staff and DOM Legal Counsel
and we will work to answer your questions.
Revised August 2022

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