92815C - Slaughterbach

`OW4, ❑CAMA ❑ DREDGE & FILL No 92815 A B C D
GENERAL PERMIT Previous permit
J Date previous permit issued •
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the yS_t}jte�f 61�rth C ro' a,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC��� ❑Rules attached. Q General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name � C" i "4+. �? Authorized Agent
Address Project Location(County):
City ` �y - Llrl� C a 1 State ZIP Street Address/State Road/Lot#(s)
Phone#( l r^_ _�� �2_C _ >
Email Subdivision —
City 4` ZIP -
Affected ❑CW n EW l PTA ❑ES ❑PTS Adj.Wtr.Body ` _ (nat/man/unk)
AEC(s): ❑OEA ❑IHA UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes.po I PNA:yes/0
Type of Project/Activity ' '1 I6
(Scale
Shoreline Length _
Access Length ^----r
Pier(dock)length
1 - t
Fixed Platform(s)
Floating Platform(s)
.�.�... _. 1 c ��
10/
Finger pier(s)
ILA
Total Platform area'"
Groin length/# 17
Bulkhead/Riprap length JT # ]
Avg distance offshore
Breakwater/Sill ! ♦
Max distance/length
Basin,channel J-4111
Cubic yards M t
Boat ramp I '
Boathous Boatlift ____--•- -
Beach BulldozingIk-
^°
Other i l
SAV observed: yes
Moratorium: n/a yes
Site Photos: �
Riparian Waiver Attached: lv�31 no i
A building permit/zoning permit may be required b : i V �� N
% - ❑TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
1 t ❑ 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#/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:
1-1 Tar- Pamlico River Basin Buffer Rules F-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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River, Onslow Fax: [phone]
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: [phone]
(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

o�0(Wr4j�G_ ❑CAMA ❑ DREDGE & FILL No 92815 A B C D
3 Previous ermit
D
GENERAL PERMIT p
Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Caro' a,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.dgq.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
Affected ❑CW X]EW PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity l
(Scale:
Shoreline Length
Access Length -
I �
Pier(dock)length
Fixed Platform(s)
i
C r
Floating Platform(s)
40
Finger piers) ) ..... _ �.. t _ .. ..... 1 I .........._ 1... -
• PIT� I
Total Platform area
Groin length/#
Bulkhead/Riprap length { . ..... ..__....... __.. . ..._ ..__( ! ..
Avg distance offshore
Breakwater/Sill
Max distance/length {
Basin,channel
Cubic yards
Boat ramp
Boathouse/Boatlift 17
Beach BulldozingNi6ii NOW
r w
Other I
j
SAV observed: yes no __..�.. .....__.HT__ �
Moratorium: n/a yes no
Site Photos: yes no. _ _........... .....f.... .._.__:.. _�_ ._ _.._ _...._�... __._._ _._ .__�....: __-
Riparian Waiver Attached: yes no
A building permit/zoning permit maybe required by: ; '� � e " r
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
ElSee note on back regarding River Basin rules
1-1 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 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:
F] Tar- Pamlico River Basin Buffer Rules F-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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River, Onslow Fax: [phone]
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: [phone]
(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

r
',('AMA DFIEDGU & FILL A i+ �D
v
GENERAL PERMIT Previous permit
Uate previous permit Issued -
�New Modification l-wnplete Relssuti, f',lrual Reissue
y •~ .,�i '. f i I4i4,tnMnt rl t n,rr.111�110.",,i Q,,,dity A"d file 1,raylJl Relrwir,M(.OlrMrntNMl in an Area Of QrwilOnrTMr,UI(tNKMn pi,ISUant t0
R, O%.tit*hell V (wf"41 Per,rut Rules ivA,lahle it the following link w,w dCq,t5. V/QAtNu1e$
+..�,�,�w,� 1 c A
�- ti-ll��1 " \ ..I r ( A,rthorited Agent
� 1
Project l,xuion(County)
State ZIP i Street s e ftd/lot klsi
ter. .
Subdivision
r
City �� .C(C� Cl_ ` .. _ ZIP
Ad Wtr Body .j'r�4.-� n tc�� "� __(nu/m ri/unk)
Ali , » ;EW X�I"A ��ES OPTS 1 Y J
i
jINA UUW SPIMA PWS Closest Mal.Wu Body 1
ORW ��` —
PNA:yel/ //
T"*Of Project/Activity 1 1111 c"QAI , K(I ) g
more, -- - 7-`-- ----- 4
ne Length
ength 1_.
oie•!dock)lengtfr� �'
'.sea Platform(s)
=loafing 4 Platforms)
/ Q �� co,:roger Pierls �tk,TrLuja Uj
.per IQ5
q A
Total Platform area
Groin iength/a
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill c • ) I
Max distance/length
Basin,channel FYI
Cubic yards
Boat ram ?
Boathoup Boatlift
Beach Bulldonn
Other _ �'-� Qk.
�J
SAV observed yes
Moratorium n/a Yes
Site Photos
Riparian Waiver Attached' (A
no p�(
A building permit/zo ing permit may be required b : V 1
Permit Conditions
TARIPAht/NEUSE/BUFFER(arch one)
See note on back regarding River Basin rules
See additional notes/conditions on back
I W AW RE OF JTATUTES,,CRC NAES AND CONDITIONS THAT APPLY TO THIS PROJECT AND RE WED COMPI ANC MEN. ( rase nmal) �'
ASentjlr Applica RINTED ame , Permit Offic P Name
2.p.plcaticin
ure••P se read compliance statement on back of permit- .�'-- Signature / 7
Fee s Z �� �; G
O Check p/Money-Order issuing ate Erpruton Din

V� ()C44p�d
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. Jay Slaughterbeck
Address of Property: 202 Roanoke Ave, Morehead City NC 28557
Mailing Address of Owner. 1336 Heritage Heights Lane, Wake Forest NC 27587
Owner's email: Sl/aughterbeck@gmai .com Owner's Phone#: [phone]
Agent's Name: ///(��f Agent Phone#: G l 44i
Agent's Email: 1,/('/,J(,�1(,-
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 forthis
Permit has described to me, as shown on the attached drawing,the development they are proposing. A
descripbon or d with dimensions must be provided with this fetter_
i 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.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 28667.DCM n4mwentatiwes can also be contacted
at(252)808-2808.No response is considered the same as no objection if you have been notrf ed 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 musk sign
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback
-0R- SkjrWure o diacent Riparian Property Owner
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner
-� � —
Typed/Printed name of ARPO: ;J�! C/i/l/! C,j�F(/� f�/f�!��,',•�a /��C/� /[,(j�,ii���l/
I
Mailing Address of ARPO:_/1`� �'��/�LC,�ir- %>/�! ( �,v� K,1.0( C _S c, F t :"l. C
ARPO's email: 1zyer�Ar F o o ARPO's Phone#: Z.S L _ 9717
*1
Date:_ T -2A/"1!j *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
1
I

41 Vo
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN REQEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. Jay Slaughterbeck
Address of Property: 202 Roanoke Avenue, Morehead City NC 28557
Mailing Address of Owner. 1336 Heritage Heights Lane, Wake Forest NC;27587
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: //l+J (� n�� 7��� Agent Phone* �-S 7 -
Agent's Email: ���� �l ii1 c r/1.1 0-,
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 prapose4 you must notify the N.C. Division of Coastal
Management(DCAQ in writing within 10 days of receipt of this notfce. Correspondence should be
►nailed to 400 Commerce Ave.,Aforehead Clty,NC 28557.DCM representatives can also be contacted
at(252)808-2808. No response is considered the same as no objection tf you have been nod ied by
Ced~Aiarx
WAIVER SECTION
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 appy to bulkheads or riprap revetments). (If you wish to waive the setback,you must stun
the appropriate blank below.)
I DO wish to waive some/ail of the 15'setback
-0R-
Signature of Ad*vid Riparian Property Owner
I do not wish to waive the 15'Setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner. t
Ty ped/Printed name of ARPO: IV/N R l
Mailing Address of ARPO: q _Ll1?/
ARPO'a lAL
Date: 2� 2 'waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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Styron, Heather M.
From: Andre Webb <[e-mail]>
Sent: Wednesday, July 17, 2024 7:49 PM
To: Styron, Heather M.
Subject: Re: [External] Jay Slaughterbeck Needed Permit
Attachments: Jay Slaughterbeck 717.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.
Hey!
We will just leave off the finger dock on the east side so we can stay in the same footprint. So we will just
extend the one on the west side of the lift and put in the new lift. I attached the updated drawing
Thanks
Andre
252-665-4378
On Mon, Jul 15, 2024 at 2:04 PM Styron, Heather M. <heather.m.styron dep.nc.90>wrote:
Hey Andre,
I am handling this now and I noticed on your phase 1 drawing it appears the new outer finger pier would be outside
of the existing docking facility footprint. Is this the case?If so, I could not issue the 2000 for this portion and it all
would need to be done through the major permit.
Thanks!
Heather Styron f t
District Manager, Morehead City
Division of Coastal Management
North Carolina Department of Environmental Quality
l>✓ ,n
400 Commerce Avenue
Morehead City, NC 28557 \ ,�
O `
252.515.5417 (0) 252.725.3903 (M)
Please note that my,entail address is now [e-mail]
1

www.deg.nc.gov
Find a Field Rep(arcgis.com)
Vo- o
A
0
From: Hall, Wayne P<Wayne.Hal IPdeg.nc.gov>
Sent:Tuesday,June 25, 2024 2:32 PM
To: Styron, Heather M. <[e-mail]>
Subject: FW: [External]Jay Slaughterbeck Needed Permit
Let me know if you need me on this.
Thanks!
Wayne Hall
Field Representative
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
[phone]
[e-mail]
www.deq.nc.gov
Find a Field Rep (arcgis.com)
2

h
�.{�Et1YE✓�1'll'NIIlrttaE i31k�B1�/
Email correspondence ;to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties,
From:Andre Webb<[e-mail]>
Sent:Tuesday,June 25, 2024 7:09 AM
To: Hall,Wayne P<[e-mail]>
Subject: [External]Jay Slaughterbeck Needed Permit
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.
Hey, hope you are doing well! I am in need of a permit for Jay Slaughterbeck at 202 A Roanoake in MHC.
It is a shared dock. I have attached the forms and drawings. I have it in 2 phases. Phase one we want to
do some demo and take out the existing lift and put in a new lift and extend the finger dock. Phase 2 will
definitely take us into a major.We gave the neighbors all of these drawings to show what we wanted to
do as well so the form will work for the GP and the Major.Thanks for your help!
Andre
252-665-4378
3

Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
4

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Wt PC,INC JAY SLAUGHTERBECK P05/14;/2024ANIM MLV 202 ROANOKE AVE UNIT A
5415 an AITOr r ROA19 re aKEWMIN,NC 28562 PROPOSED DOCK / LIFT PLAN PHASE 1
rwlNon ey aot. 252-665-4378

Styron, Heather M.
From: Hall, Wayne P
Sent: Tuesday,June 25, 2024 2:32 PM
To: Styron, Heather M.
Subject: FW: [External] Jay Slaughterbeck Needed Permit
Attachments: JS PHASE 1.pdf;JS PHASE 2.pdf,JS Demo.pdf;Jay Slaughterbeck Cama Forms.pdf
Let me know if you need me on this.
Thanks!
Wayne Hall
Field Representative
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
[phone]
Wayne.Ha1l.Pdeq.nc.gov
www.deq.nc.gov
Find a Field Rep (arcgis.com) av)
.. SO
BE
ED,.E
N;
r Oparomm of i"ronow"i aual.ty
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From:Andre Webb<[e-mail]>
Sent:Tuesday,June 25, 2024 7:09 AM
To: Hall, Wayne P<Wayne.Hall @deq.nc.gov>
Subject: [External]Jay Slaughterbeck Needed Permit
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.
1

Hey, hope you are doing well! I am in need of a permit for Jay Slaughterbeck at 202 A Roanoake in MHC. It
is a shared dock. I have attached the forms and drawings. I have it in 2 phases. Phase one we want to do
some demo and take out the existing lift and put in a new lift and extend the finger dock. Phase 2 will
definitely take us into a major. We gave the neighbors all of these drawings to show what we wanted to
do as well so the form will work for the GP and the Major.Thanks for your help!
Andre
252-665-4378
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
2

1
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Nance of Property, Owner Requesting Permit
Mailino Address >�
0`one Number-
email Address ill • Sl��q�lbecu �` �VV�G !) . (1
i cer-tify that I have authorized
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
Inecessary for the following proposed development: tom"/<
t �
at my property located at ZOZ 4 Z4 Iyo&*ma GiT-Y I've-
County
t
! furthermore certify that I am authorized to grant, and do in fact grant permission to
Divrsion of Coastal Management staff, the Local Permit Officer and their agents to enter
-)n the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Sig ure
Pnnt or�y�Name
Title
---- Gate
-. , .r:ttihr ettgn is valid through I
I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICAT10N1WAIVER FORM
t^FRTiF_W MA)L REn RLC�IPT RE U QQ a►�..-ND pL��E�-Y
(Top pMion to be completed by owner or their agent)
Name of Property Owner (a 21�f`J7
Address of PropedY- 0 0
IyW"AddreO of Ownerk Ai
hOwner's email: owner's Phoned -7Ly
rnu;r ,("M
Agent's Name- A,'��J' �/,l���!�� Agent Phone#
Agents Email: l !'«!.'!'�� �' �': ./r tl /_•�.r .
ADJACENT RIPARIAN PROPERTY()WNEf t-SwC�EQRT*-ICyATTII.O.N�
torn portion to be compkftd by the Ad
I hereby certtry try Ii^own property adjacent to the above referenced ply.The imfividual 3PPIN- 9 fOf this
permit has desaibed to me. as shown on the attached drawing.the devebpmeW they are Woposm9. A
desc'xia/tics or dmwirgl wRh dir�s must be provided with tlx$lett -
i V i DO NOT have objections to this Proposal. I DO have objections to this proposal.
J'f yvv Dave objections to what is be&g ProPOSe4 1w nKISt notify the N.C: DAdslon of Coastal
ll� -9enfent(DCAIP in writing within 10 days of smeefpt of this notfm cornmpondeme should be
rrgfJed to I00 Coarrnerce Ave-,AtotWood CJf%NC 29567.DCM r8presentadves can also be contacted
at(252)So -2s0R.No response Is eonsideredthe scrag as no objection Jryou tare been notified by
Certified ME
WAr4M 3EC110N
1 understand that any proposed per.dock.mooring pilings.boat ramp.breakwater,boathouse, lift.or
groin nrusi be set back a minimum distance of IV from my area of riparian access unless waived try me
(this does not apply to W*heads or romp revetments).(11 you wish to waive the setback,you mug slat
the appropriate blank below_)
1 DO wish to waive some/alof the I
Signaten>9 o/Ar�soent F►'o�perty Owner r ��
-OR- /
I do not wish to waive the 15'setback requirement(iti68l the blank)
Signature:of Adjacent Riparian Property Owne
TypedJPrinted name of ARP(): rl��l•�ri, •� /i� /� f r (���/.�.t/
Mailing Address of ARP(): //'/ it,
ARPO's enw*.2 a c G Ver jtio,f tJO U��`pO(Aftms Photo Z
Daft:6 'waiver is valid for up to one you from ARPO's SiprWun-
Revised May 2021

N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERT)FIE q MAII. RETURN RFEJPT REQI� ,nEUq[HAND DEUW_Ry
(Top portion to be completed by owner or them agent)
Name of Property Owner I f 114 J S
Address of Property: � �EYP(,l�.Q J � � /1 7if 7
Mm&V Address of Owner 1 � t`� n L� ��V�b l VIXi F�eh7 Nc,YLS`7
owners email: Owner's PhoneO
•uyJ
Agents Name: /91'` Agent Pttorte0
l
Agent's Email: h .�l :�� n„ o✓r,
ABAACtPIT RIPARIAN PROPERTY OYYNER'S cat?FiCATm
(BOlE10m DOrtion to be Opitpk1ftd jM tail!Adim*r*Pmpmtr Owrra�
1 hereby candy that 1 own property add to the above ret+ m;ed property.The individual applying for this
Pem* has described to me. as shown on the attadred drawing.the developmerrt they are pmposirtg. A
desari 3hon or dmwirto with drrtensions mast be Provided with this letter.
_�I DO NOT have ob*bons to Nil-proposal 1 DO Rave objections to this proposal
you haVV objections to swift is beft P, ,-, m-eq you mast naffs►the IILC. Division of Coastal
mc"In wroirg Wme 10 days of mcierbt of this nodce. Contaspondence shadd be
ntadedto 400 Commerce Ave..Yadhead Ciaty,NC 2>l U.DCYrap vsertbtltres can also,be contacted
0508-o�R.No response is consideredtbe some as no objection ffyou have bear noWlied by
WANFR SEC ION
I understand that any Proposed pier.dock.rrtoodng piin9s.boat ramp.Drealoaaler,boaNt Xg;e..Ut or
groin must be set bads a n**mffn distance of IT room my area of dparian aomss unless waived by me
(this does not apply to b Adteads or nprap revetments)-(if you wish to waive the setback,you MMIU
the appropriate bier*below.)
I DO wish to waive sornefall of the 15'setback
Sombse a(A*wentr R o ian Property Owner
I do not wish 10 waive the 15'setback regtrtrement Oni ial the ME*)
Signature of A4scwd Riparian Property Owner.
Typedl 4inhed name d ARPO: S
I' S1 j
M� C'a y�ni,� �:� -( ' ARNYs Ptwnel: `f I cl
Dab: : 2- 'twlv.r is valid for `E up to one roar holm ARPO^s Signature'
Rbvised May 2021

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_______________
WV17C,INC JAY SLAUGHTERBECK 05/14/2024
WEI36 NR
ANPM
202 ROANOKE AVE UNIT A :p-i
3413 OI ?AAPPOKT ROA19 w.
NEW KIN,NC 28562 PROPOSED DOCK / LIFF PLAN PHASE 1
by,aet. 252'665'4398 1 OF I