101382C - Barefoot

d ` I�CAMA DREDGE a FILL ___ i A B D
GENERAL PERMIT Pre"°us`e—lit �° i 3
A
Date previous permit issued I 0Z,I
[]New [Z Modification L Complete Reissue ❑Partial Reissue
As authortred by the State of North Carolina,Department of ErwlrortrwMai Quality and the Coastal Reso,xces Commisslon in an area of environmental cnncern pursuant to:
15A NCAC_LL_LLI_J 1t ❑Rules attached. L] General Permft Rules evadable at the following Ink-
Applicant Name_71-6 S I (' `" uv - Acehorizad Agent_---- L_----- -_ -
Address 4 S 5 ��Oq►m _._�oA_�_ Profect Loatlon(County):
Gry & m 54y► State „fit/ C ZIP 0 Street AddretwState Road/lot (s) /�oZ 3 4(� y f•t^'�"m
Ema11 ra,tl d g Z C �t c, c UA, Subdivision
city AAtiti ..ry --Zip aBSll i
Affected ]CW Z EW ®PTA ,ES ❑PTS �.V aft ody_ L O re �y0- n (I Itan/unk)
AEC(a); Flom _7MA ❑LO � DSPIMA MPWS CleantMa(.Wtr.Body. (��t" �V' e-k,
ORW;Yes/40 PNA:yes,f9
Type of ProieW Activity v• '4C D%�y t-z ✓rh n-� q��I
(Stile:N rS►
Shoreline Length --
Access Length - - - - - - —
Pler(dock)length a - -- n - Y- - �-�- �- - - �• -
Fixed Pladarm(s)•_� t �- � �-
FloatingPiatform(s) !1 Fingerpleds) --
Total Platform area -
i
Groin a,rglh/N_-•- -�-�� _ - - -rt- -(. .___ .- ~. - --'r- �, .. -ra• - - -
Bulkhead/Rlprsp fensih
Avg distanceaffohore -�- - - _;__ __� _ _.I f! _ Ji... _ __t-
Breakwater/Sig.
Max distance/length -'�-;_ _ --i-• - --� '�-- - - --�- -i-- --',-- -
- - -'
Basin,channel -- - --f_
Cublc yards
_w
Rost ramp - - -t - - -f- - - - - -- - -
�l
••�� /mac•/�7-•�-^ -� - .OJ--Beach Bulldoiing_^1
Other -
r
tj—
SAV observed:
Muratwlum: n/a VOt
R� tm�WahxrAttached: �' L�!�'- ..�.. _ .._1... -l. �. _�{ v �^ - -- -L
AfuN*%wrmVzonirapw n-A mayberequimciby;.-L ....'��fi~ _. -L fi.�•I. �-��
TAIV
PcrmttNAMINf:U5EA3UIi ER(drake ate)
/�
°7 a' --e�- 1 --- — YID/�-n`�-- 91•�L_ ❑W nMc an back mranikW WdK B20n odes
Lb-
-2 Sae addlcrn tkl antes/-t wn&tkw%on back
C�]
t AM AWAE or SWUT S,CIIC AtlilS CrJNOR10NS YwtT APPkY]o YM PRU"I AND RfVtMO C.O PUANCE SIATEM ENT. (Pkese lf*ko-- _ -
AgrM .pp!tnnt F•Rfh rFD Nano` Pt-'ir.t CJ!fRr1'�Wiik'tc�Nelnt / ��
gnat L3 rat hacR o tk•• - e
ppir,r, chsdl SpAta ey omw kMA46 046dbQkllfatr UeM/

[9CAMA ❑ DREDGE & FILL -- A B D
.J@1Previous permit D g�
GENERAL PERMIT Date previous permit issued (0 3
❑New U 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 62 7 f 200 ❑Rules attached. ® General Permit Rules available at the following link:www dcq.nc.aov/CAMArules
Applicant Name Zn,"Q S (� "�P 'c t Authorized Agent
Address 4�/��4 A"I j Project Location(County): 6.1'4-t✓CI
city 6 P H Sdil state it/ C- zip a 7 J C��1 Street Address/State Road/Lot#(s) R A 7 ©Q S 4,g
Phone#(ql�) II gg_ 5-3 y;z R co A
Email-fit6 dA Z/ , T I,1C, 'C O L-A Subdivision City, Cl e >/✓'Y zip
Affected ❑CW ®EW ®PTA ❑ES ❑PTS Adj.Wtr.Body
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal.Wtr.Body y` C4—,
ORW:yes/& PNA:yes,(a
Type of Project/Activity ti
e , ly �✓�`� 07.c fx�1t7��1��
(Scale:/1/r5.)
Shoreline Length
Access Length - - -=-- -_ - - - -
Pier(dock)length O`t - I-- - -- --1-- - --i
Fixed Platform(s) 8
-- - -- - - -- - --� _ _ -. - -- - - -- -.i - � - 2, - --- --A -
-I-- — � --
Floating Platform(s) - _i-- - - -- - I_ -[._.' _i_Cl'1..�! Q
Fingerpier(s) - - ' - --'— - - ' — - - -- - - -- --- - - - - -
Total Platform area _�__ -
Groin length/#
Bulkhead/Riprap length
r
Avg distance offshore
Breakwater/Sill - --�_ __ ' _i� _ _ j _ "{"_ _ "? _�_ __ _ __� _-
Max distance/length -
Basin,channel
Cubic yards -�-- - --�- - - �1 _- '
VAS
Boat ramp --I f _ _ i- - t
Boathouse/
l J
Beach Bulldozing —
t_
Other aAFL
SAV observed: yes F�-- - -Moratorium: n/a yes --
Site Photos: yesRiparianWaiverAttached: no
A building permit/zoning permit may be required by:
Permit Conditions 1-Vil O' 117 le, lnleee4l ❑TAR/PAM/NEUSE/BUFFER(circle one)
00 G 29 / ,qA,L k 1LIU I-/- ❑See note on back regarding River Basin rules
a e pft ❑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" 518nature
Application Fee(s) Check q/Money Order Issuing Dati( Expiration Date

ECAMA --' DREDGE & FILL N9 101382 A B C' D
GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina.Department of Environmental Quality and the Coastal 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.mdCAMArules
Applicant Name 1 __ Authorized Agent
Address Y 55 4 1 f — Project Location(County): --
City State ZIPS cf Street Address/State Road/Lot#(s)
Phone#(____) 3�—des✓ — —
Email Subdivision
City. ---- ZIP R --
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SMMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: ,7 S)
Shoreline Length
Access Length i
Pier(dock)length �/ !
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/Riprap length W/ 4/i/�
Avg distance offshore f 1
Breakwater/Sill
Max distance/length 4F..14 1 ✓
Basin,channel
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing /
Other �(
SAV observed: yes no CL
Moratorium: n/a yes no ; / y �q✓1/
Site Photos: yes no r;. .i;1 y/ ►"G
Riparian Waiver Attached: yes no (Lrd lJ b
A building permit/zoning permit may be required by: n 1-.
i- ❑TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
__ _ _ _ _____ _- _ _ y ❑ 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)
( G.
Agent or Applicant PRINTED Name ) Permit Officer's PRINTED Name
Signature•'Please read compliance stateriient on back of permit" Si natur4
o
Application Fee(s) Check#/Money Order Issuing Date a Expiration Date

Channe-I Sep back
v
b p
-7 000 lb,
�t 1 F�
s 'x
r

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PRO N SEC OPT R R UOEST D D IOA DADEL_VERYIVFR M
CERTIFIED MAIL RE __._ _--
(Top portion to be Completed by owner or their agent)
JAMES BAREFOOT
Name of Property Owner. --
823 OLD STANTON ROAD BEAUFORT NC 28516
Address of Property. ------- -
455 NOAH ROAD BENSON, NC 27504
klailing Address of Owner:
9+s soa•s��
Owner email MULE0AZEArNccom ()wtler's Phorlelf: 9
Agent's Name. �1PtST.�I[ Agent Phone#,z5Z-Zai-69b2—
Agent's Email D uo I l r u +tl
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portion to be completed by the Adjacent Property Ownen
I hereby certify that I own property adjacent to the above referenced property.The individual applying for this
pe".it has described to me, as shown on the attached drawing. the development they are proposing. A
des4 1 lion or d th dimensions must be provided with this letter,
I DO NOT have objections to this proposal. — 1 f)O i ave objections to this proposal
ff you have objections to what is being proposed, you most notify the N.C. Division of Coastal
Afanagement IDCM) 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%752t 808-2808. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I inderstand that any proposed pier. dock, mooring pilings, boat ramp breakwater boathouse. lift. or
groin must De set back a minimum distance of 15'from my area of riparian access unless waived by me
(tha does not apply to bulkheads or nprap revetments) (if you wish to waive the setback. you must SiQ
the appropriate blank below.)
I DO wish to waive somefall of the 15' setback
Signature of Adjacent Hiparran Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Ownto. k �--,4
u
Typed/Printed name of ARPO:
Mailing Address of ARPO: 1 j,;3 5jjh� GAPE Gkl �- W Nti l N-%AI rM NL 21107
ARPO's email: ilriulnr,KENNLUt1y1dit..4AIL.to ARPO's Phoned: h_4?1_yu4,
Date: —44a/1 •waivor is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFI CA(TIONIWAI ER FORM
CET R�p MAIL TU N RE. IP R
ERY
(Top portion to be Completed by owner or their agent)
Name of Property Owner. �I�M�`� ZF11af[Y�T
AAdreSs ofP'mPertY
�l3 01,17 grtAI�TbN R-D BERuF�7T, I
mailing Address of owner: y55 Nt7A�� RD C*J '
Owner's1AutEDPZEL TwL ,Cc7f�l :.,i ��r • phnnelt- qlq 5bLA9
' tQ7-
Agent's NamF-, IJEwN► SUt.Y� MA 2i�� Co►�Anent Phone#:,_ a.5o'? a► 1 (off
Agent's Ernat i.)S►,�LLG M h r L • CIO
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bot ortion to be compiyted by the Adjacent Property Owner)
1 hereby certify tha:I owr 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
des=bon or drawing with dimensions, must be provided with this letter.
(,J?t - ? DO NOT have objections to this proposal. I DO have objections to this proposal.
H you have obJecdons fa 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 2.8557. DCM representatives cart also be contacted
at i252,1 808-2808. No response is considered the same as no objection It 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 revelments). (if you wish to waive the setback, you must sign
the app -pnwp blank below.)
I DO wish to naive Surrxw/ali of the 15' setback
-OR- Signaturn of Adjacent Riparian Property Owner
l do riot wisri to waive tfre 15'Setback requilemunt (initial the blank)
Signature; of Adiacent Riparian Property Owner
Typed/Printed name of ARPO:
Mailing Address of ARPO: - r--
th.lc�r YY� . Y ..-yr_'f 1n __�E���_�� c• L.
ARPO's &mail:
ARPO's Phone#:
Date: _�y .1 - 'waiver is valid for up to one year from ARPO's Signature-
Revised July 2021

`°"S44,&❑CAMA ❑ DREDGE & FILL N� 101382 A B C; D
0 4- GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal 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 ���� c+✓t" i Authorized Agent
Address A S G4 } Q Urn Project Location(County): n
City r,, - y ✓! ap State A/ ZIP 7 Street Address/State Road/Lot#(s) d S><�1
Phone#(�) 7D 3 y 2
�r
Email Subdivision
City b. ^���/✓� ZIP
Affected CW ®EW Q PTA ❑ES ❑PTS Adj.Wtr.Body �4' man/unk)
AEC(s): ❑OEA ❑IHA ❑UW SPIMA 11 PWS Closest Maj.Wtr.Body
ORW:yes/no. PNA:yes/n9
Type of Project/Activity CSC
' (Scale: /{/j z)
Shoreline Length 1!
Access Length
i
Pier(dock)length `j S(l IV
Fixed Platform(s) 7 o" /
I �r
Floating Platform(s) -- � . i• � "�
Z
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill I !
Max distance/length
Basin,channel j 1 ji
1
Cubic yards
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 {L o 5 C+
A building permit/zoning permit may be required by: If4 Lle& L h
Permit Conditions 11II . + (..i. L,
1 " d 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)
` c�) I R.r= c ,C
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
�Signature**Please read compliance staterCent on back of permit** Si nature
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 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.+°tCOArk&❑CAMA ❑ DREDGE & FILL W 101382 A B C D
Previous permit
GENERAL PERMIT
Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal 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 1 Project Location(County):
City State %' ZIP Street Address/State Road/Lot#(s)
Phone#(_) 1�§g_
Email Subdivision
City ZIP G
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑IDEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale:
Shoreline Length
Access Length
Pier(dock)length { t
Fixed Platform(s)
41 e
Floating Platform(s)
_. _
Finger pier(s) { "'
I r
Total Platform area
Groin length/# 4
- x
Bulkhead/Riprap length �--- �,---- I
1
Avg distance offshore
Breakwater/Sill
Max distance/length }
p s' t
Basin,channel M. l
Cubic yards
n
Boat ramp
Boathouse/Boatlift
Beach Bulldozing 77y
Other
SAV observed: yes no
dr.. ( �. '>
Moratorium: n/a yes no
Site Photos: yes no - 11
Riparian Waiver Attached: yes no �'�� "' I )� J
A building permit/zoning permit may be required by:
Permit Conditions � ❑ TAR/PAM/NEUSE/BUFFER(circle one)
4
❑ 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 f
�1
Signature"Please read compliance statement on back of permit" Si n_atur + l _
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 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

_LN T-RFs-'T-PL ._. _ W A- - '
a
I �
w U
Cl\i
M M
� W
m U 2
c� m _' W
1--6 �-o r--
/ 2,�0 12doo 12c�, O
14 e&Fcto
Z7Sd�-

Na 'I
�6 --�
S
VNA Pc 6Z
i
S
h� N
I- �-_0 T
J2Sc�
i.._V �� ���}`may ti (/F'•`f F�..,.y.^"„'^,,.,.
r Q
W
N
f=1 -
> `V 0
Lij
til o A LIJ
1 t

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED
Date
v 2
N me�o�dja�c\e�ntORiparian P� er Owner
Address RECEIVED
l�S©N �C- 27.Sd
C-rty, State Zip S E P 1 1 2024
To Whom It May Concern: DCM-MHD CITY
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
h o t c r) Pi l l tax---�c
on my property at �S'%"7-2W 1 ;� af�F` l /"C-
in 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:
(LOCAL PERMIT OFFICER,NAME OF LOCAL GOVERNMENT,MAILING ADDRESS CITY, STATE,ZIP CODE)
If you have any questions about the project,please do not hesitate to contact me at my address/number listed below,or
contact(LOCAL PERMIT OFFICER)at(PHONE NUMBER),or by email at: (LPO EMAIL).
S cerely,
919' 3 g
Prope er's Ntne Telephone Number
��� �6 A-[-F Tom-- �f �•[5�,� /`l.� 2 7 SSU
Address City State Zip
I have no objection to the project described in this correspondence.
I have objection(s)to the project described in this correspondence.
/AN)T-A A A�df
Adjacent Rip Signature Date
4l 9 F?-C) C0 8C`�
Print or Type Name Telephone Number
Address City State Zip
Revised July 2021

1 14
{
ill _ '�.. ... - .! ,. •- .,..
!( .`e':. --y: .J`� ,. 1,' .. ,.1. .. �I.r/ ,�(' .. .. •is 7���i• .. .. •.r i I. '✓'.�. . is ..
. (, ;� i4 r.. ..�ZSr,. ' `c_t•14��J" ,.�. t..`/J�.` ,: �i{. .t ,.i �� ;J _. - ,. � .
r
'k.•eyr"LY+:.r•.,.:,sv*:*aay.yu'.a.AiaNGIG'.+if91.,am:9:'•+3.As.YIRWx�s.R fl-'n:.a:KY.F:�..+sRFFih_.:ba's.,v:,•:;,_*f..,•3 ac•.` +.'w1MA.:- w'4.Y'•.:�cc.nt�+.Wr Gn rk;rne,Mx::.rK•�eaoi¢.�
tr;ji / � rl:is ;��' ..F•., i ,"t Pi,:�'
i'L:.aY'k'. -...,.. .•.Y$bel.'�LYC..Y�twF4tNO/N'•f3.af+:by�7N..y+,,:5•�il9MirR.`LiRtt.:.:4h3' �StlIVtM- a._.a..'f�-.,itlYF1L5i#•'i�M$K1WY�MdMy. ;1044L^r�P.•-�r�"gat'r+.�7�•N'.+a4`Y:A=�1/.`••{'Jp�'.
J:rldr rt' � lyt• J 1.

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) RECEIVED
Name of Property Owner: 1 2024
Address of Property: c v z CITY
Mailing Address of Owner: n /4C
Owner's email:�Y►UC QZ TI�x=rCO►llOwner's Phone#: 0 3 g :5-3
Agent's Name: DENNIS & SONS MARINE CONSTRUCTION, LLC
Agent Phone: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom-portion to be com Ip eted 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.
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
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
-OR-
I do not wish to waive the 15' setback requirement(initial th blank) �(K
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: I
Mailing Address of ARPO: �'t'f .�"%o/��Cof�j �D fi�ll�.5' S�LO�I 294/19�v
ARPO's email:KGB R (!GxTI�n�/�(l� ARPO's Phone#: .fin 7 2`t� CQ�5
rK 41 t-i CEO/V 1
Date: —c5 —Z *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021