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HomeMy WebLinkAbout92854C - Yost '30�01` 41 ❑CAMA El DREDGE & FILL { C&W-aW No 92854 A B C D iS,@GENE P R M I T ��A� Previous permit% L Date previous permit issued [:]New �464d6i Icati omplete 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: 15A NCAC ❑Rules attached. ❑ General Permit Rules available at the following link:www.dgq.nc.Yov/CAMArules Applicant Name Authorized Agent Address Project Location(County): 61 City State ZIP Street Address/State Road/Lot#(s) Phone#(_) Email Subdivision City ZIP Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk) AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mai.Wtr.Bod ORW:yes/no PNA:yes/no 1 Type of Project/Activity (Scale: ) Shoreline Length � .✓ r� a Access Length `'` All I / Pier(dock)length ' Fixed PlatformsANZ Floating Platform(s) Finger pier(s) 15, Total Platform area Groin length/# Bulkhead/Riprap length J`( Avg distance offshore / Breakwater/Sill - - -•a----- •�• � Max distance/length Basin,channel Cubic yards Y Boat ramp Boathouse/Boatlift Beach Bulldozing Other r SAV observed: yes no -' Moratorium: n/a yes no _ Site Photos: yes no .` Riparian Waiver Attached: yes no ^- --- 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) IY�rC `y" Agent or Applica t 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 I 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: 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 COAST",&❑CAMA ❑ DREDGE & FILL NO 92854 A B C D 3° GENERAL PERMIT Previous permit 3 � 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 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 Authorized Agent Address Project Location(County): City State ZIP Street Address/State Road/Lot#(s) Phone#(_) Email Subdivision City ZIP Affected ❑CW t EW PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk) AEC(s): OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body ORW:yes/ o PNA:yes/no ) ?( { Type of Project/Activity (Scale: = ) Shoreline Length, I / Access Length Pier(dock)length .t ( r { '_. Fixed Plafformis vpi(r) f Floating Platform(s) :Act Finger pier(s) \ ' Total Platform area 7 t t Groin length/# i Bulkhead/Riprap length Avg distance offshorei — f Breakwater/Sill - r Max distance/length Basin,channel ` Cubic yards J i441 ,Boat ramp Boathouse/Boatlift- Beach Bulldozing t ! Otherk\ SAV observed: es Y o Moratorium: n/a yes no Site Photos: yes no .� �- f.-�-� � } Riparian Waiver Attached: yes no ,•e .„ ,, __, r ! A building permit/zoning permit may be required by: Permit Conditions :+ ❑TAR/PAM/NEUSE/BUFFER(circle one) " ' !ti'' t + r i (._� y ' ❑ See note on back regarding River Basin rules �' �, n C ❑ 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) ,r Agent or.App ca t PRINTED Name Permit Officer's PRINTED Name Signature**Plea ead com tatement on backAf permit** Signature 10 Application Feels) Check#/Money Order Issuink 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-1 Tar- Pamlico River Basin Buffer Rules F1 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 3oN_*LOW41 DCAMA ❑ DREDGE & FILL No 92854 A B C`D GENERAL PERMIT Previous permit Date previous permit issued N6nNevv ❑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 ❑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 Affected ❑CW ❑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 i (Scale: ) Shoreline Length Access Length , - r Pier(dock)length Fixed Platform(s) -- _ - — — - Floating Platform(s) l ; Finger pier(s) t Total Platform area Groin length/# I ' ; Bulkhead/Riprap length ..-_...._ Avg distance offshore Breakwater/Sill ! i Max distance/length Basin,channel _ - { 1 Cubic yards Boat ramp Boathouse/Boatlift !G Beach Bulldozing I f Other SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no ..... t - - t _ Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: ❑TAR/PAM/NEUSE/BUFFER(circle one) Permit Conditions ❑ 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) MAA Agent or Applicant PRINTED Name Permit Officer's PRINTED Name A`9 A Signature"Please read com iaoce.statement on bacl�af permit" Signat re Application Fee(s) Check#/Money Order Issuin—g D� 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-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: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 Docusign Envelope ID:8855E970-B93B-4581-BDF7-AO9C946AOE20 B � CAMA DREDGE & FILL ------ {'rswr(}U4 6sPrtTtrt GENERAL PERMIT DVAWPt Pll""" t r3,i�1l+d�"• New Modification Complete Reissue )Psrtial Reissue A'_MNwrezrb- i _• - -d 11"CAW(1�lksdbpR!C + m rvr vs+et�r.�wurxnrrxal<cr.ceN+v�'"j°'ar t0' ty1. ,<(-��ar(�(�J,KMv�*rryr,t rf Fmrrcwr+rM+r�l A+uHtY •1�: {;A tir'aV: ..���r }�V�.J.—._ t LL R4aw nrtacraed 1 ... tmk-.W"h�r+',dlh1.M;.k'•�"r.',l_^1"�'v. f J � r`�Gwnorat pmwnpil.,kx�maAtlAe art eMrkA�aw*`p "•PJr.arn hAarn.v ../1G AutMwruq ARart^•.�'~•, ��.lC�I V�/! // �,�,•/y�y.,�,,,�� Pro4eettraeauarlGc:ur/teyw# 1r.f..F✓ 'fQ,,,,/,�����, � �• �/^�. ! L •isa�'a'✓! �� Srrem Aalrkns�V 1+tnr li /,•v"""°t.(/t�'" —7 r .lr('W �x!rW �TA FS FIFITS All)Wtf,W41Y .,. ACC; i p@A i tNA W !._.�SMMA �_�FIWS Ctuest M.y.Wtr.(sex r t-A PNA SPs/ of Project/Artfvi 01i ri - V, "r zsate:t :✓ ) }".f4C15 tr.n(jth�Y„•,,,..r .,_... d __.•__._. � 11 �/n ' R{Et f4ncij srt.gs 11 . �"• _ FtxrdPt�ti9xm(st r 't,aTfr�3't''taTii'+yntrstJ"""""'..�....._ 4 t:t sa*'hlri'Tf 3!'4:K E�Y/S.��r%�;-^��,. ( � �I)/��•'�'X 58 a �^ .Axe Ors.,+,>.rCp ofl't►tarr•. .,-.._........_._._,..�_.._ Max d{Ftantr*J tt nor i It"r 'rd}"`"`�"• ._. ._.._.__ e, Initial e _ .. t1 i • ttkALL_ i ar�sf>~.nns��7 V ll.Y. �,�w"7 "°'l`•. .� a� . '1 w VP _.4lrrtwt)te�aty»�BtsStee�r�dttr��vnta;�ci t fif QFST FUtES CfiC RULES AND CONDITIONS IHAiAf'Pt}IU tNISPNWIt.I ANIikEYI[ €.t,►M1 ANI�' �)ASP �• _„ r aca PtNTER Name_ 4qgnatll d Compliance statement on back of permit" Ch�t6 '�M1fc r�ity f�rtlr�r i•);Ur) '1.f� .,.ttvor SEA' 0 6 ZUZ4 nr-nn nnun t-1-r / D—,.%,9n Envelope ID'.8024CB22 A9554369A304C928853E107 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion Jo be completed by owner or their agent) Name of Property owner: I/ �44�-,- A�rj lJ Address of Property: VC ID Mailing Address of Owner: / XEW3C— AC, Owner's e ma 1, J1U Owner's Phone#- `7 Z ?0 Agent's Name: Agent Phone#:___ Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent 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, 6 description or drawing, with dimensions, must be provided with this letter. Zl 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 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.) Signed by: I DO wish to waive some/all of the 15' setback E Gt�l� L KwyL" - �ig<—nature 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:x___ Typed/Printed name of ARPO: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 b zU24 DCM-MHE) CITY Docusign Envelope ID:8024C822-A955-4369-A305-4C928853E1D7 ICAMA DREDGE & FALL ----- � ENERAL PERMIT ildAued in ''" i1Ncw Modification t_a"Complete Reissue 17 Partial Reissue 11n 'l�L�j�,(`W t.�lP,KftTM+t tl��mkdnlfl+'fOti QuMIRy d fh!rn.MdR((!�[Rh�l'[K�+NIRNttl(AY fn M illy N1 liWkNMM�t� I t,A lil."A /' t r`l x .�fiynnrsi ft—w Nul*xv^Axbi*A vl**AOw*lr,tiNt•,YtH'IA,dIo4 ,• ' 11 AN.•,i+,9 f+tirn,i ^� ..r. St+•HMhfrve t yNl,n to CRY C .cw rw V rrS I..-.�OtS Adl Wit' ci'J j 'AfA ?Ilia �.~j SA1MA FWS1 Ci...W Mnf Wtt,IS POOA of Project/Actitri R ,` a►n " n ---. . t Initial Ilk v, ( The, �y`+ FxiAgrf qr<. .,: LM'1•Jl'iC: >J�f �rw"r f'i ".. �„ �e""i ,,rr • i'�tdlti�e .�Y� ra6/' I I�p.�Jr. _• ��� • J 1��1�(✓, i\,'a.s�,r"J^,]lWr<���.,.S,.E�St 1Ctv+�r".�44�1e1 r \.M`da"S•i+t'Ly"ta Pt'"SCbc"t"�51S:ic*F{s 1'1S1 tk.54? #rE OF 5T TUTES CRC RULES AND CONDITIONS iHAI APPty I tl I H6 PHOJI t I ANU HI VII r ooro AMi t IAli a Pt•nritt Ulf i t 1 ,cRINTI?Name i' fT N,tNt rad cramptrance statement on baJ of permit*i — Stgnat e �hrck glMatiey i3rd•�r Iss^t,in��atF� t:xtsitat��nt7�te mwi SEP 0 b 1dZ4 41 Dowsign Envelope ID.g855E910-893B-dSBt.BDF7A 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) jr Name of Property Owner. 70Ai — Address of Property: �F-3z WA q Mailing Address of Owner: g7 J�JoLic)2�- Owner's twner's Agent's Name: Agent Phone#: Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Ad' cent Pr2oertv Owner) I hereby certify that I own property adjacent to the above referenced prop".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 yriu 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 I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, ot 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,) Signed d by: I DO wish to waive some/all of the 15' set/bk C -c OC6D8443486C447, Signature WAdjacent 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#: Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 I1 0 DCM-MHD CITY El a ID E1A51`044-AEB2-4!2;44ED F224BE=31 N.C. DIVISION OF COASTAL MANA EMENT r ' wV 01 kY P� ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM �L CERTIFIED MAiL RETURN RECEIPT REQUESTED or HAND DELIVERY J (Top portion to be completed by owner or their agent) Name of Property Owner: /�}�l G / t t i✓,( 4 / Gi'�Pu � Address of Property: r✓e- 0 Mailing Address of Owner: e, Owner's emai - r j.jar Owner's Phone# 2 L) 'I L. 3 c 17 7 L fry('G Agent's Name: Agent Phone#: Agent's Email: 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 descri tion or drawing, with dimensions must be provided with this letter. 1 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 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.) Signed by: i DO wish to waive somefall of the 15' setback R'Awr_ . ,-I F�nGi�inrc1-..., ignature 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:x Typed/Printed name of ARPO: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Date: *waiver is valid for up to one year from ARPO's Signature* REMVJulyD E2021 AUG 16 2024 DCM-MWD CiTY D--gn E-Mope ID:D69EB482-F2C3-4BC9.9F3[)-643DOA22376E N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPAR.iANDROPERTY OWNER NOTIFICATION[WAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY (TOO portion to be completed by owner or their agent) Name of Property Owner 70A,1" Address of Property: Z_ 1-:7 W/A a Mailing Address of Owner: Z�u Owner's ernaiQ01�'/ ,_So,4) co wrier's Pt)one#,-(, Agent's Name: Agent Phone#., Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owners I hereby certify that I own property adjacent to the above referenced property.T he individual applying for this permit has described to me, as shown on the attached drawing, the development they are proposing. A d-escription.or drawing, with dimensions, must_b_eprovided with this lettu r. I DO NOT have objections to this proposal. I DO have objections to this proposal. !f you ave objections to what Is being proposed, you must notify fhe 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 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,) Signed by: I DO wish to waive some/all of the 15' setb k 43486C447_ Signature jf"�idjac�;�t�Ri arian PropertyI r Owar -OR- ------- I do not wish to waive the 15' setback requirement (initial the Signature of Adjacent Riparian Property Owner-, Typed/Printed name of ARPO: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Date: *waiver is valid for up to one year from ARPO's Signature* REC gftbluly 2021 AUG 16 20 DCM-MHD CITY y 1 s RECEIVED .� AUG 16 2024 • �' DCM-MHD CITY ' � r P I li II I li I li t i I c�