78707A_Bunch, Allen_20210108

/ AMA / AWEDGE & FILL N9 78707 CA
GENERAL PERMIT Previous permit # B C D
1-New Modification Complete Reissue �_�Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in air area of environmental concern pursuant to I SA NCAC
�i__ at e -tac 5
Applicant NameAter,_ ....... Project Location: County,,_- kr-
Address Street Address/ State Road/ Lot #(s)
City State Alr-, Zlp;_L�S�K'
Phone # E-Mail r_C,_..TfAAA
Authorized Agent 1,21TIV, City ZfP ;)L;t
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Affected Cw OFTA D ES k-*S Phone# River Basin,J;
AEC(s OEA L­ i i HHF 1H 0 URA 0 N/A Adj. Wtr. Body 4-c, kk�,j 4,t_4_r_i;t A.'
MS: pag.6juPOA
ORW: yes / 160) PNA yes /(Dno Closest Maj,Wtr. Body . .. . .. ............
Line. . ... ................... ............. ..........
Agent Applicant Printed Name
.............
Signature ** Please read compliance statement on backof permit"
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Application Fee(s) Check #
PermitOfficer' Printed
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 4L,,e,-.i J- ��•�-��-
Mailing Address: POP, Poisi2 5' 1
Phone Number: `__�LS '� — Ll S� '_:� _tLk
Email Address: F� rp J FAA 6 t4,Q (Q A4 4IL_ .Co✓�'�
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �F UL.-\.<- ti ,46
at my property located at I Dl I 1 d s (0601Q015 F 5- ,
in County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluatina information related to this
permit application.
Property Owner Information:
,,-Signature
Print or Type Name
Title
Date
This certification is valid through
Receilicd
OCT 0 J ra
DMEC

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner
Address of Property:
Agent's Name #:
Agent's phone #:
4L Lic"-J T 3010&1q
(Lot or Street #, Street or Road, City &
Mailing Address:
7Vrc
OCT 0 3 KU
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 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property OwrierJnfo ation)
Signature
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Print or Type N me
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Mailing Address
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City/State/Zip
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Telephone Number/ Email Address
(Adjacent Property Owner Information)
Signature
Print or Type Nam
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Mailing Address
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City/State/Zip 1
Telephone Number / Email AP dress
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner Xd ,J T 9L-Lv[44
Address of Property: D6
(Lot or Street #, Street or Road, City & County) RecEilid
Agent's Name #:
Agent's phone #-
Mailing Address: OC1
I hereby certify that I own property adjacent to the above referenced property. The individual
aopiying 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 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signatjpf
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Print or Type Name
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Mailing Address
City/Statelip
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Telephone Number/Email Address
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Date
(Adjacent Property OwWT Information
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City/Sta elZip
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