HomeMy WebLinkAbout89056A - OBX Land Partners, LLC`Jta"r CAMA El DREDGE & FILL
�. GENERAL PERMIT
ONew ❑Modification Complete Reissue ❑Partial Reissue
N9 89056
Previous permit
Date previous permit issued
0 B C D
As authorized by the State of North Carolim, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC - 2 111
/ 1- M cs ❑ Rules attached.
❑ General Permit Rules available at the following link: www— ,A.nc,goy/CAMA„ les
Applicant Name d.b7�
1-4 A- ,4-, a.r.ST L LC-
Authorized Agent `%l u 2, w I`Qa r.41 u,
Address M D
c �. sly
II.{'
2e'J
Project Location (County), Gib
City -1�0. l t,: st-- State t� C ZIP .Z.Si2-//
Street Address/State Road/Lot A(s) N C 7
Phone ay (m) `i Es
!j
Email 0.r " StLCar
@ Q.r Z 1o��pCc,/\
Subdivision Aro �'1 C(ti Yf
City, 4^�Z-JC&4 ZIP
Affected ❑ CW
0. (2rm ❑ ES ❑ PTs
Adj. Won. Body IC m Q A o �Ga-//-Sr . L fn a dunk)
AEC(s): ❑OEA
❑IHA ❑UW ❑SPIMA ❑PWS
Closest Ma). Wm Body ^•� n,n U /C fl T"'- ..d—`J
ORW: yes/no PNA: yes/no
Pier (dock) length Z
Fixed Piatformis) (. .
/ 2 -AY 3 z4
Floating Pletform(s)
Finger pler(s)
Total Platform area .2
Groin length/R '•
Bulkhead/ Riprop length
Avg distance offshore
Breakwater/Sill
Max distance/length
Cubic yards
h_1 _I-r I
411t6r, lz .A
/2b ?. & A-r
/osc ( -X /
3 Xs/ ®1. ('Rr&i
Boat ramp —
BDathou a%Boz1IJt
J
.t�
Beach Bulldozing r
�D
Other-J.5(.lk
y/
SAV 40
�1
observed: .� yes f
Moratorium: yes no Slte
Pho
X��V'
s�
,I. [W: yes nRite
WalyarANached� yes C',
A building permlt/zoningpermh maybe required by:
T)' iL C- �
Permit Conditions
P
C>
❑ TAWPAM/NELISE/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 THATAPPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please lnitlal)94-Li'19
Q�Yae—ryyr-"~, vp"IA� CtirJA�
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
compliance statement on back of permit's sig ure
Check p/Money Order Issuing Date Expiration1)
& CANIA ❑ DREDGE &�FIILL N° 89056 q� B C D
a GENERAL PER
yAIT D tepre io slpermitissued
VINew ❑ Modification Complete Reissue []Partial Reissue
As authorized by the Stat/Ieffof North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 7 41 , / 2 0 0 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deo.nc.gov/CAMArules
Applicant Name � �/�
Z-ZA n C &T2& 2/S . L L L
Authorized ,Agent ,� q
�4�" (—i✓r A
Address D
� 1;:
�e1
ra n
2" s,k- Ko �
Project Location (County):
�rA
�+
C
City -h0-r1 o �s+— State fJ 'L zip Zx2-tt
Street Address/State Road/Lot #(s)
—�.J Al C �S
Phone#(`?n�) 9Jy
— 69I6 (
II
Email 0.l—'�' 5Q-CorQ R,/W /MAL oi/t Ceti
Subdivision ck-
C&)LX
City LJ ra
ZIP
Affected ❑ CW
&4mL 'PTA ❑ ES 1-1PTS
1®
/2'79fnl
Adj. Won Body /�. e O. A 0 µ wL at/rlvan/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW ❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body �b a
//Ss
9
K/k e � SG `A n. d
ORW: yes/no
PNA: yes/no
Type of Project/Activity �2—a� 7C Cx r P: } (. / a c/ G P /cam i �tatir t� !2-(X- Y/ m,
�t ti S4-S rs 3',cYr si. c/��' ny � �r)c/`/' Bea- t- 4=fis w/ r, J (Scale:Af❑ )
Shoreline Length
Access Length
Pier (dock) length /.Z J K Cp
Fixed Platform(s)
/2-?f 4,c�
Floating Platform(s)
Finger pier(s)
Total Platform area �2Z
fls �ti7r: `4' `A
Groin length/#
/210 ?- G �4a�
Bulkhead/Riprap length —
�`�''C/kq/ (Lfy
Avg distance offshore
Breakwater/Sill '�
a�!`frC�y L•i-Sr
Max distance/length
x Gr (A o.
Basin, channel
Cubic yards
v
Boat ramp
cs
Boathou a/Boatlift � 1</
Beach Bulldozing —
D
Other Lk
J
cl, SIN
V
SAV observed: yes ro)��
Moratorium: <Zayes no
��
' Lk`�
1'
Site Photos: <0 ny
Riparian Waiver Attached: yes Cn.
A building permit/zoning permit may be required by:
�1"rZ Cn v^A
Permit Conditions _
)NS THAT APPLY TO THIS PROJEC
Agent or Applicant PRINTED Name
Sign ture "Please read compliance statement on back of permit•*
Application Feels) Check q/Money Order
Q�ANDKN
w
D ,
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
JD REVIEWED COMPLIANCE STATEMENT. (Please Initial)°
�y � n nQ- C w_r J2�-,
Permit Officer's PRINTED Name
/ / Y
Issuing Date Expiration Date
,Moor" ❑CAMA ❑ DREDGE & FILL NO 89056 A 1 B C D
Previous permit
GENERAL PERMIT Date previous permit issued
FT]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:
I SA NCAC )�'� f 'J " _=' ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq.nc goy/CAMArules
Applicant Name "•'� y"d�1 `i'=t-fn'=.�.5 << �- Authorized Agent '•(%"�\::
Address `-: `� �` '' "si Project Location (County):
City State ZIP--X' �- // Street Address/State Road/Lot /�i <i."L=
Phone # ( IZ.,
Email "x. % ip �n. , c�,.,, ,, J• o ; . n_ Subdivision i <
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body "r �' "^ `( ((naUmanfunk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity "
4 (Scale: AJi . 1
Shoreline Length,
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
other
SAV observed: yes no
Moratorium: h/a yes no
Site Photos: . yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAWPAM/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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit** I Signature
Application Feels) Check p/Money Order Issuing Date
(Please
Expiration Date
y
PARCEL 6
PARCEL 7
496,939.21 Scl.Ft
11.41 AC.
PROPOSED PIER
6'X120'
nL 1
WALKWAY i
404 NEYTAND LINE
PARCEL 8
1O'X16'
3'X4'
LEGEND
- 30' DCM BUFFER LINE
- 75' AEC LINE
- EXISTING NORMAL WATER LEVEL
GENERAL PERMIT SITE PLAN
®BX LAND PARTNERS, LLC
PARCEL 7 / CAROLINA CAYS
WANCHESE— DARE COUNTY — NORTH CAROLINA
30' 0' 60' 120' 180'
now
GRAPHIC SCALE 1"= 60'
DATE: 05/10/23 REVISED: 06/05/24
ATLANTIC ENV/RONMENT,4L CONSUL TANTS, LL C
P. 0, 90,v 3266, KITTY 114WK, N. C. 27949
(252)261-7707, e-mail dougo'oeoggmail, oom
FILE: OBX LAND PART 2023 DRAWN BY: DAD
AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2561 PAGE NO: 511
STREET ADRESS: Parcels 1 through 24, Carolina Cays, 0 NC 345, Wanchese, NC 27981
Please Print:
Property Owner: OBX land Partners, LLC
Property Owner:
The undersigned property owners of the above noted property, so hereby authorize
Doug Dorman of Atlantic Environmental Consultants, LLC_ to,
(Contractor/Agent) (Name of consulting fine)
1. Act on my behalf and take all actions necessary for the processing, issuance and
acceptance of permits and/or certifications and any all standard and special
conditions attached.
2. Enter the property to obtain site information including inspections with regulatory
agencies (Dare County, North Carolina Department of Environmental Quality,
U.S. Army Corps of Engineers, etc.) for the purpose of obtaining permits and/or
certifications.
Property Owners Address (if different than property above):
120 Greenwich Road, Charlotte NC 28211
Property Owners Telephone Number: 704-904-0861
We hereby certify that the above information submitted in this application is true and
accu
rate to the best of our knowledge. c
Ao)
Authorized Signature and I e Authorized Signature and Title
Date: % O9 zao z Date:
This certification is valid thru (date) 06/09/2025
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: OBX Land Partners, LLC
Address of Property: Lot 7, Carolina Cays, 0 NC 345, Wanchese, NC 27981
Mailing Address of Owner: 120 Greenwich Road, Charlotte, NC 28211
Owner's email: art.secor@lwlandmail.com
Agent's Name: Doug Dorman
Agent's Email: dougdaec@gmail.com
Owner's Phone#: 704-904-0861
Agent Phone#: 252-599-2603
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto 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 or coasrai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at (252) 946-6481. 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
11411112
I do not wish to waive the 15' setback requirement (initial the blank) TCC
Typed/Printed name of ARPO: Toby & Amy Chai
Mailing Address of ARPO: 144 Blue Hills Road, North Haven, CT 06473
ARPO's email: toby.chai@bmc.org ARPO's Phone#: 443-762-6843
Date: 05/28/24 *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: OBX Land Partners, LLC
Address of Property: Lot 7, Carolina Gays, 0 NC 345, Wanchese, NC 27981
Mailing Address of Owner: 120 Greenwich Road, Charlotte, NC 28211
Owner's email: art.secor@lwlandmail.com
Owner's Phone#: 704-904-0861
Agent's Name: Doug Dorman Agent Phone#:252-.599-2603
Agent's Email: dougdaec@gmall.com
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
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
matted to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at (252) 946-6481. No response Is considered the same as no objection If you have been
notified by Certified Mall.
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 somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) Ay
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: OBX Island Time, LLC
Mailing Address of ARPO: 207 Running Cedar Lane, Henrico, VA 23229
ARPO's email: b.verdery@sydnorhydro.ComARPO's Phone#: 804-338-3568
Date: 05/28/24
*waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021
¢`0"WfCGIENERAL
AA,MA ❑ DREDGE & FILL �, (` N9 89758 U B C
Previous permit PERMIT Date previous permit Issued
ld�jNevv []Modification []Complete Reissue ❑ Partial Reissue
As authorized by tjsg ynse I ; ,lina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC �K rt Rules attached.e_neral Permit Rules available at the following link: xommft.nc.eov/CAMArute.
Applicant Name O PBX Loch d
Address b G re c A rA)
city .( o c I— e state nl zip 28 2 I 1
Phone #( b'), ?oq OX6 f(
Email (lri', .c a Go r o16s1(<lndrnad` Co .K
Affected DCW
AEC(s): ❑OEA
ORW: yes/no-)
V5EW ®PTA
[]IHA []UW
Type of Project/ Activity
PNA:
Shoreline Length
Access Length '"—
Pier (dock) length J zs -(¢_.___
Fixed Platform(s) 10 Is: / CP
Floating Platform(s)
Authorized Agent �� c+—to o� �p rm O ,+
Project Location
Street Address/State Road/Lot#(s) %
0 A)c. pus
Subdivision C ah.ro /i ti 0.- C o- V s
City 0 w J, s.J c., r zip Z-77S'%
Ellis n PTS Ad). W'tn Body R � aA O iCn. ._S osw n d man(unk
EJSPIMA E]PWS Closest Mal. Wtr. Body A o * n b k%- -S .w
Finger pter(s)
rJ
Total Platform area 'J,
Groin length/d
Bulkhead/Riprap length _
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Boat ramp
Boat hous BoatliN
Beach Dulldozfng
Other
SAV observed: yes no
FrtpERAc e N naTNE� sET6hcJc
L
J., Aw
JPa
5
Moratorium: I n/a yes no
Site Photos: es no t
Riparian Walver Attached: TFS8
A building permit/zoning permit may be required by:
Permit Conditions
0,Ito r'st4%-S
ftRP' Km��
(scale: nl7 1
p Ct it4p-
fa
TAWPAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rule!
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 lnitlaQ
y�Dcue- bor<"eae✓
Agent or Applicant PRINTED Name
�Cg atureLe ease read compliance statement on back of permit"" ,
Application Fee(s) Check H/Money Order
PLArrIt Officer's PRINTED Name
ture/
�y3 A— 1i 3 1Z 3
Issuing Date Expiration Date
AUTHORIZATION TO ACC AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2561 PAGE NO: 511
STREET ADRESS: Lot 7, Carolina Cays, 0 NC 345, Wanchese, NC 27981
Please Print:
Properly Owner: OBX land Partners i 1 C
Property Owner:
The undersigned property owners of the above noted property, so hereby authorize
Doug Dorman of Atlantic Environmental Consultants. LLC to,
(Contractor/Agent) (Name of consulting firm)
1. Act on my behalf and take all actions necessary for the processing, issuance and
acceptance of permits and/or certifications and any all standard and special
conditions attached,
2. Enter the property to obtain site information including inspections with regulatory
agencies (Dare County, North Carolina Department of Environmental Quality,
U.S. Army Corps of Engineers, etc.) for the purpose of obtaining permits and/or
certifications.
Property Owners Address (if different than property above):
120 Greenwich Road. Charlotte. NC 28211
Property Owners Telephone Number: 704-904-0861
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
Authorized Signature and T' e !/
Date: r61,04+ 20 Z.
This certification is valid thru (date)
Authorized Signature and "Title
Date:
North Caroline Secretary of State Search Results
httl)s://www.sostic.gov/online,_services/search/t3tisiness _Begistratlo..
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List - View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
OBX Land Partners, LLC
Information
Sosld: 2260997
Status: Current -Active O
Date Formed: 9/1/2021
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Secor, Art
Addresses
Mailing Principal Office Reg Office
120 Greenwich Road 120 Greenwich Road 120 Greenwich Road
Charlotte, NC 28211 Charlotte, NC 28211 Charlotte, NC 28211
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
OBX Land Partners, LLC
120 Greenwich Road
Charlotte NC 28211
Reg Mailing
120 Greenwich Road
Charlotte, NC 28211
I of 1 6/23/2023, IOAO A
I TK,c:
wd
Measurement
Clear
DocuSign Envelope lU: 926C72OD-10EU-487F•8757-174OUE09tiEA7
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 OBX Land Partners, LLC
Address of Property. Lot 7, Carolina Cays. 0 NC 346, Wanchese. NC 27981
Mailing Address of Owner:
120 Greenwich Road, Charlotte. NC 28211
Owners email: art.secor@lwtandmail.com Owner's Phone#: 704-904-0861
Agent's Name Doug Dorman Agent Phone#: 252-599-2603
Agent's Email dougdaec@gmailcom _
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,
ff you have objections to what is being proposed, you must notify the N.G. Division of Goasrar
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mail, Washington, NC 27889. DCM representatives can also be
contacted at (252) 946.6481. No response is considered the saine 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 §tan
the appropriate blank below.)
100 wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Properly Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
TypedlPrinted name of ARPO: KMK Outer E
Mailing Address of ARPO: 5 McPherson Lane, Bell Mead, NJ 08502-4321
ARPO's email: Imaddineni@gmaii.Com ARPO's Phone#: 609-865-0825
Date: 06/12/24 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021
T�� 7 a a�� �/La • Y�Z�rZ�
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. OBX Land Partners, LLC
Address of Property: Lot 7, Carolina Cays, 0 NC 346, Wanchese, NC 27981
Mailing Address of Owner: 120 Greenwich Road. Charlotte, NC 28211
Owner's email: art.secor@lwlandmaii.com
Agent's Name. Doug Dorman
Agent's Email dougdaec@gmail.com
Owner's Phone#: 704-904-0861
Agent Phone#: 252-599-2603
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_,
�j 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 943 Washington Square Mail, Washington, NC 27889. DCM representatives can also be
contacted at (252) 946-6481. 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.)
100 wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
No
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: —P--' member of Gillespie 6rmp LLC
Typed/Printed name of ARPO: Gillespie Group LLC
Mailing Address ofARPO: 168 W. Main Street Unit 563, New Market, MD 21774
ARPO's email: zimmes@protonmail.com ARPO's Phone#: 301-807-4814
Date: 06/02/24
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021
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