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HomeMy WebLinkAbout1-24 PERQ MOD - Tolleson, Edwin and PatriciaElizabeth City Field Office MODIFICATION Local Government 1-24 PERQ Perquimans County Permit Number CAMA°`(OAS '41 MINOR DEVELOPMENT x PERMIT as authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission for development in an Area of Environmental Concern pursuant to the Coastal Area Management Act, Section 113A-118 of the General Statutes. Issued to Edwin & Patricia Tolleson, authorizing development in the Estuarine Shoreline (AEC) at 153 Flyway Dr, Lots 62M & 63M, in the Holiday Island subdivision, Hertford, Perquimans County, as requested in the permittee's application, dated November 17, 2023, dated received January 29, 2024, and a subsequent modification request received April 1, 2024. The original permit, issued on January 30, 2024, and the modified permit issued on April 3, 2024, is subject to compliance with the application and site drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void. This modified permit authorizes: The partial placement of a dwelling within the AEC, a 10'x10' concrete patio, a driveway and parking area, tree removal and grading of the property. (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawings dated received January 29, 2024, for tree removal and grading, and the work plat drawing dated received April 1, 2024, for the dwelling, a 10'x10' concrete patio, a driveway and parking area within the AEC. [GS 113A-1201 (2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations, applicable local ordinances and FEMA Flood Regulations. [GS 113A-120] (3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and modification of this permit. [GS 113A-120] (4) A copy of this permit shall be posted or available on site. Contact this office at 252-621-6450 for a final inspection at completion of work. [GS 113A-120] (Additional Permit Conditions on Page 2) This permit action may be appealed by the permiltee or other qualified persons within twenty (20) days of the issuing date. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. Any maintenance work or project modification not covered under this permit, require further written permit approval. All work must cease when this permit expires on: DECEMBER31,2027 In issuing this permit it is agreed that this project is consistent with the local Land Use Plan and all applicable ordinances. This permit may not be transferred to another party without the written approval of the Division of Coastal Management. Check #2400, in the amount of $100, was received on 12/1412023 for the permit fee. Ron Renaldi NC Division of Coastal Management 401 S. Griffin Street, Ste. 300 Elizabeth City, NC 27909 PERMITTEE (Signature required if conditions above apply to permit) Name: Edwin & Patricia Tolleson Minor Permit # MODIFICATION 1-24 PERQ Date: April 3, 2024 Page 2 (5) The amount of impervious surface shall not exceed 30% of the lot area within 75 feet of Normal Water Level (Estuarine Shoreline Area of Environmental Concern), in this case, ±1,208 square feet (10.74%) is authorized. [07H .0209(d)(2)] (6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all development/construction shall be located a distance of 30 feet landward of normal water level. No portion of the roof overhang shall encroach into the 30 ft. buffer. [07H .0209(d)(10)] (7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area has been properly stabilized with a vegetative cover. [07H .0209(d)(3)] (8) Any proposed for grading within the 30' buffer from the normal water level must be contoured to prevent additional stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must remain in a vegetated state. [07H .0209(d)(3)] (9) This permit does not authorize development within any wetlands or open water areas. [GS 113A-1201 and [07H .0205(d)] SIGNATURE. X DATE: PERMITTEE blpalrlGAT19>�[ k4J1L�s. F]omcq 1--a�i9 Local04wommeNt parmst Number PMgUIFNR1 Courtly t1om CAMA fA k) MINOR DEVELOPMENT a PERMIT rwwrp.e w ter Buts o+h+ m owwra.ersk ar [-41-17x of 4 "W ..y ans a+r GlefM legarcr ICO//M�frUra>•r Ilef 4 R W Ar.. ee ha "m pxnW* Oesins Coa[+1Arr Menperr�.kR 9neAlon ILla�4a4 dew rar...0 srwr.+!r., lss5x4 rrr Cij�vf�13 Bella Tom -on, eaUxNvrg dewetasrnant n Irlt Gsa!entw Sly ali la (l Ci at tE;s FLyvssy lnls 4k. 4 C2M R Ciw, in Ilia liakiny Ist; (d s,.4ldiMrssidt, tkrikxd. 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W Voe wA plat & M4-rl dated lrracrmd *11, ?QX, In1 Ife dworKLai0xtn'r e1.o0jo.a#mwMaraiWIkgimaWIMMACC.IGS113AA201 C10 Al abtolaralardstararcx 10liltUtfvW arreeo*A 3tA 12V all,gul t� lk M?� amFe"altcyv�ldtro-lts, q I I [ 4! k7 chary Or KJ($ al LW pails IN dM0Off c0. corgi' .> l „ r:s LA rsn aXtb s wit recp4e a wwab6m; and m)6fr:a5atc4Mmil. [GS 113A-1201 (4) A tnpy od Ibis peim4 shnl N OWN w 3ra an still. C+orltact Ibis oft aI 252.621.4450 kX a brae k-kSpe-d<m at cm"bonolwok CGS IIIA.120j IAddill d PW" GondVm alp Pap 71 DA MM.,.urn ,nrf to w11 matr#h&f powo rm .atnne*rr�?,srzd8i+io-r..r�hrm d%appenllawsba�lMftf� rAa aid a�x.^asaz x IF mrm Mhm till .prorad to ftww $of p*G•�'ia7oQ, %t( tttiar,'�npg'rrtak +?r $Ap�C41 IafddFif?Jle M dl'�r 11+»erc�L wfids+foal+,all�ppPdlydLMwskea®IG(N��1BvtP+i! 1 T*mrrirr f0Ibak +"-*dto snp mw d ina m say t# ow" teas eo:eNo ar, I M= far Rut IieKIB46 NC Usiend fAWJ limppNot 01 S. 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IOYH AMOU (81 J,ny PIK_^41of Y wlhb" 1 a Nekor `A-.n : re rAnn-d w.ter kryd fLe b0: M(IInPj OJ hW31 gv_, '31Cr runWl rk lha, x*M pursh Tris area Ook:ri itkt>edal(,* vCIAtcudy sLob4zed. irk' muel rernin in a my-l6lod slaw, j0?)1.02OWdA311 j9► rr�s r'r'eei .:Ws nel 4WIrd-fL deveiopmr'tG mV,i+l 3ry w0anft or r#prxt wa'Ior 21e4ts (GS i1 M-i201 and [07H .d205 iJ4 t I L _ t i, I �- t .A i I - i E i I I j 1 1 W 3 t Li ^tea I. �.Ci_--'- ''-----'-' -- -- --"- '� I -- l 1 i 1 1 i N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT) CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED Cassandra Mclean Name of Adjacent Riparian Property Owner 134 W Island Trail Address Hertford NC 27944 City, State Zip To Whom It May Concern: APR - 12Uz4 DCM—F—C 2e-2Y Date This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to modify permit to include part of Manufactured home at 60' off canal with stairs back door, driveway and patio on my property at lot 63m flyway drive Hertford NC 27944 in Perquimins County, which is adjacent to your property. A copy of the application and project drawing is attached/enclosed for your review. If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no comments or objections regarding this project. If you have objections or comments, please mark the appropriate statement below and send your correspondence to: NC Division of Coastal Management (DCM) at 401 S. Griffin St., Ste 300, Elizabeth City, NC 27909. If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or contact DCM staff at 252-264-3901. Sincerely, Edwin Tolleson Property Owner's Name Address City (757)270-3742 Telephone Number State I have no objection to the project described in this correspondence. I have objection(s) to the project described in this correspondence. Ct-ht� 3•2-6 ,Vy Adjacent Riparian Signature Date Cassandra Mclean Print or Type Name Address City Telephone Number State Zip Zip Revised July 2021 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT) CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED Linda Presley Name of Adjacent Riparian Property Owner 15525 HWY 561 Address Halifax NC 27839 City, State Zip To Whom It May Concern: RF,("I F IV rI) APR 1 2024 DCM-EC Date This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to modify permit to include part of Manufactured home at 60' off canal with stairs back door, driveway and patio on my property at lot 63m flyway drive Hertford NC 27944 in Perquimins County, which is adjacent to your property. A copy of the application and project drawing is attached/enclosed for your review. If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no comments or objections regarding this project. If you have objections or comments, please mark the appropriate statement below and send your correspondence to: NC Division of Coastal Management (DCM) at 401 S. Griffin St., Ste 300, Elizabeth City, NC 27909. If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or contact DCM staff at 252-264-3901. Sincerely, Edwin Tolleson Property Owner's Name (757)270-3742 Telephone Number Address City State I have no objection to the project described in this correspondence. I have objection(s) to the project described in this correspondence. &Y-4, ga�—� - Adjacent Riparian Si c ature Linda Presley Print or Type Name Address City _3-a9-a� Date Zz/-4070 Telephone Number State Zip Zip Revised July 2021 I tj o\� EF It I LL LiI F 17 3 t Fv. I LT 7 1 -4 PIP 10� 1 01 -LJ 14- I iSlt> t=)yv-�y * V Percluimans County Local Government CAMA MINOR DEVELOPMENT PERMIT 1.24 PERQ Permit Number as authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission for development in an Area of Environmental Concern pursuant to the Coastal Area Management Act, Section 113A-118 of the General Statutes. Issued to Edwin & Particia Tolleson, authorizing development in the Estuarine Shoreline (AEC) at lot 62M & 63M Flyway Dr. in Holiday Island, in Hertford, as requested in the permittee's application, dated November 17, 2023, received on January 29, 2024 and received complete on January 29, 2024. This permit, issued on January 30, 2024, is subject to compliance with the application and site drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void. This permit authorizes: Tree Removal and Grading of the lot. (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawings(s) dated received on January 29, 2024. [GS 113A-120) (2) All construction must conform to the N.C. Building Code requirements and all other local. State and Federal regulations, applicable local ordinances and FEMA Flood Regulations. [GS 113A-1201 (3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and modification of this permit. [GS 113A-120] (4) A copy of this permit shall be posted or available on site. Contact this office at 252-264-3901 for a final inspection at completion of work. [GS 113A-120] (Additional Permit Conditions on Page 2) This permit action may be appealed by the permittee or other qualified persons within twenty (20) days of the issuing date. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. Any maintenance work or project modification not covered under this permit, require further written permit approval. All work must cease when this permit expires on: DECEMBER 31, 2027 In issuing this permit it is agreed that this project is consistent with the local Land Use Plan and all applicable ordinances. This permit may not be transferred to another party without the written approval of the Division of Coastal Management. Check # 2400, in the amount of $100, was received on 12/14/2023 for the permit fee. Cynthia Rountree Field Representative 401 South Griffin St., Suite 300 Elizabeth City, NC 27909 PERMITTEE (Signature required if conditions above apply to permit) Name: Edwin & Patricia Tolleson Minor Permit # 1.24 PERQ Date: January 30, 2024 Page 2 (5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must be installed between the land disturbing activity and the adjacent wetland or open water areas, until such time as the area has been properly stabilized with a vegetative cover. [07H .0209(d)(3)] (6) All development shall comply with the following mandatory standards of the North Carolina Sedimentation Pollution Control Act of 1973: [07H .0209(d)(3)] (7) This permit does not authorize development within any wetland or open water areas. [GS 113A-120] and [07H .0205(d)] '-V PERMITTEE DATE: 1/30/2024 Locality Permit Number Ocean Hazard Estuarine Shoreline ORW Shoreline _ (For official use only) GENERAL INFORMATION LAND OWNER - MAILING ADDRESS Name Edwin & Patricia Tolleson Address 2004 Rock Lake Loop Public Trust Shoreline_— Other RECEIVE® JAN 2 9 2024 airy Virginia Beach State VA zip 23456 Phone (757)270-3742 Email. :To I) ese n EA &Innrr I C vv\ AUTHORIZED AGENT Name Address City State Zip Phone LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.) Lot 63M Flyway Drive Hertford, NC 27944 DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) tree removal SIZE OF LOT/PARCEL: 9600 square feet .24 acres PROPOSED USE: Residential Ed (Single-family ® Multi -family[]) CommerciaUlndustrial ❑ Other ❑ COMPLETE EITHER (I) OR (2) BELOW (Conlact your Local Perurfl Officer ijyou are flat sure tvhlch AEC applies to your properly): (1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but excluding non -load -bearing attic space) (2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT UPON SURFACES: square feet (includes the area of the foundation of all buildings, driveways, covered decks, concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.) STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater Managetpent Permit issued by the NC Division of Energy, Mineral and Land Resources (DEMLR)? YES NO V OTHER PERMiTS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FiA Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and others. Check with your Local Permit Officer for more information. STATEMENT OF OWNERSHIP: 1, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person listed as landowner on this application has a significant interest in the real property described therein. This interest can be described as: (check one) s air owner or record title, Title is vested in name of Tolleson, Edwin Lee & Patricia V see Deed Book 551 page 86 in the Perquimans County Registry of Deeds. _an owner by virtue of inheritance. Applicant is an heir to the estate of probate was in County. _if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application. NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS: I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit. (Name) (Address) (1) Lewis, Thomas H 4187 Needlerush Drive Lexington, KY 40509 (2) Presley, Linda S 15525 HWY 561 Halifax, NC 27839 (3) Mclean, Cassandra 134 W Island Trail Hertford, NC 27944 (4) ACKNOWLEDGEMENTS: RECEI I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which may be susceptible to erosion and/or flooding. i acknowledge that the Local Permit Officer has erlpWea t�r SYIr• the particu- lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza- tion and floodproofing techniques. r' CM_EC 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. This the 17 day of NOV 20 23 Edwin Tolleson Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application This application includes. general information (this form), a site drawing as described on the back of this application, the ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and any information as may be provided orally by the applicant. The details of the application as described by these sources are incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action. �� .��-��t`p� 'F. Pf SITE DRAWING/APPLICATION CHECKLIST Please make sure your site drawing includes the following information required for a CAMA minor development permit. The Local Permit Officer will help you, if requested. PHYSICAL DIMENSIONS _ Labelroads Label highways right-of-ways Label local setback lines Label any and all structures and driveways currently existing on propel Label adjacent waterbody , PHYSICAL CHARACTERISTICS Draw and label normal high water line (contact LPO for assistance) Draw location of on -site wastewater system If you will be working in the ocean hazard area: Draw and label dune ridges (include spot elevations) Draw and label toe of dunes Identify and locate first line of stable vegetation (contact LPO for assistance) Draw and label erosion setback line (contact LPO for assistance) Draw and label topographical features (optional) If you will be working in a coastal shoreline area: Show the roof overhang as a dotted line around the structure _ Draw and label landward limit of AEC Draw and label all wetland lines (contact LPO for assistance) Draw and label the 30-foot buffer line DEVELOPMENT PLANS Draw and label all proposed structures Draw and label areas that will be disturbed and/or landscaped Note size of piling and depth to be placed in ground _ Draw and label all areas to be paved or graveled _ Show all areas to be disturbed Show landscaping NOTE TO APPLICANT Have you: • completed all blanks and/or indicated if not applicable? • notified and listed adjacent property owners? • included your site drawing? • signed and dated the application? • enclosed the $100.00 fee? • completed an AEC Hazard Notice, if necessary? (Must be signed by the property owner) FOR STAFF USE Site Notice Posted _ Final Inspection Fee Received t2�1 cfieK' 31�� Site Inspections 2 ® « \ » � % & / � a . 2 ' / \ } RECEI\IED 1A {5ID . 2 . / / � } \ s pt 01 % y»�\ \a/~ ®® \ \ ` 1. K N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT) CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED Cassandra McLean Name of Adjacent Riparian Property Owner 134 W Island trail Address Hertford, NC 27944 City, State Zip To Whom It May Concern: 11-17-2023 RECEIVED 1AN 2 9 2024 DCM-EC Date This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to put a Dock center of bulk head and grading of lot on my property at Lot 63M Flyway drive Hertford NC 27944 in Perquimins County, which is adjacent to your property. A copy of the application and project drawing is attached/enclosed for your review. If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no comments or objections regarding this project. If you have objections or comments, please mark the appropriate statement below and send your correspondence to: NC Division of Coastal Management (DCM) at 401 S. Griffin St., Ste 300, Elizabeth City, NC 27909. If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or contact DCM staff at 252-264-3901. Sincerely, Ed Tolleson Property Owner's Name (757)270-3742 Telephone Number Address City State ✓ I have no objection to the project described in this correspondence. I have objection(s) to the project described in this correspondence. CnAY1_ Adjacent Riparian Signature Cassandra McLean Print or Type Name 20� Date (P L)3 3 5S 1 $til 11 Telephone Number Zip Address City State Zip Revised July 2021 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION PERMIT) Linda Presley Name of Adjacent Riparian Property Owner Lot 46N Flyway Drive Address Hertford NC 27944 City, State Zip To Whom It May Concern: 1 /6/2024 Date This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to grade lot 62 & 63 on my property at lot 62 & 63 flyway ddye Hertford NC 27944 in Perquimins County, which is adjacent to your property. A copy of the application and project drawing is attached/enclosed for your review. If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no comments or objections regarding this project. If you have objections or comments, please mark the appropriate statement below and send your correspondence to: NC Division of Coastal Management (DCM) at 401 S. Griffin St, Ste 300, Elizabeth City, NC 27909. If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or contact DCM staff at 252-264-3901. Sincerely, Edwin Tolleson Property Owner's Name Address City (757)270-3742 Telephone Number State I have no objection to the project described in this correspondence. I have objection(s) to the project described in this correspondence. (d d/ P",] Adjacent Riparian Signature Linda Presley Print or Type Name Address o25-d eaxacrn 5%jn'rs d(cQ City Date 20V _Zz1— Z/a7rl Telephone Number Zip State /{ C Zip a229 d 7•Vt43Pv1.-Irr)A'A fO _ ATc 400) 0 b?t3OVIO —1 '.' r=F�iil1 s�'S `^�:..'•f�}i7y' 6A C.30 t.fh .� c<: .r S? iF.`5���'.��1 ��rl�,'; �t ��l'i r'I �fi-.;.i� �i� �Y�.S .. ?i 4lE.-: ':BQ n �itl vT ; ; i4`1 r':1 v Fv� tr:•J7=11aI 'Fra xnv,v' .. .- - '-- -. .. -. - -Cd, !C;,' !� � gig: •: __ :i . . - ,rug: y .:{..;. ... v Ut•:. hi -, 1`::f ")!if:. ��S` I'!' .I :I v(' `:' I. "I'tI i ({ yi', . I(1.. Jif.{. 11.-J`J:..:I(1'/ :I :, ..,:. ':I i,. .I. r.u: 1( El:• 'J 'i I, ...I rl. . :'i ".Y.' ''. .. u : _ .T•: .0 ., <.j• .! 9�(`.::• .t; .,. ... . Ir.. " .. -• •'L J• I: Lr. � I.-. I?'J [i" ,"•;:; i i '. :: :,ri _, :fP,. ..'. nr.: i..n� :{ x,:1.•'.-w;2..;T:Y5`:W^..GRiR.+;+!'€pFAII+'AER'A/M'.�'6FiAFb15.W:�Pi'A4fRP9�!S4:YC2S•lVR!^_TY9MtMY3df.FSSie.SIB'A0!!>�N.34LYL:.1d.5•^.YKi;w':4p??fiTl!!44«.1:NS:sIX*kc�:i9giI.LS!,`rcl'fn 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: Edwin & Patricia Tolleson Address of Property: Lot 63M Flyway Drive Hertford, NC 27944 Mailing Address of Owner: 2004 Rock Lake Loop Virginia Beach, VA 23456 RECEIVED Owner'semail: etolleson@cox.net Owners Phone#: (757)270-3742 Agent's Name: Agent Phone#: iAu 2 g 2024 Agent's Email: EC 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. 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' 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#: 24 - ZL/- Lve Date: % - / 7.4 'waiver is valid for up to one year from ARPO's Signature Revised August 2022 TO.W.-IF i lnec'F; i,,qri, io 9a 0 0 o") oiqvo1,?!A :!P cisr'A"'O -2 V* -I V,ulwm Rii�i k.; a xJR�i.Wa *3 0 VW-4a wi q M W, r, *3 0 W-- a Z M.-W. 7- A 4, W ,w f