79270A_Blum, Charles & Jill_20210609

AMA i - DREG OB & PILL Y) 79270 0 B C D
TewENERAL PERMIT Previous pw77* 0
ModMeation -'Complete Reissue Partial Reissue Date previous permit issued
As atxhortacl by the State oI North Cwo kw Department of Emiro owntal Qw ty O
and the e* asnl Resources Commission in an area of wwwwxnencal cotxern pursuant to I SA NCAC
NUN
Applicant Name C 11 Ll R i U. ._.._ Project L.ocstion:
Address ��,Q_ -L�y' .✓ _ �— Street Addr*W Scare Roadv tot #t(s)--
Cny -eaw fv✓j scat$ hic zip 213 Lae- Q� ._.r.
SubdMvbfon�_�yt.✓1 �Jftlq54
A+ishor d Age.5k,ms�.Ch1'__..
Affected cw XEW X"A is _ Phone +P
River Basin _ P
AEC(s), OEA = HHP IH uYA WA Adj. Wtr. Body_
rvvs:
ORW: yes IAm "A4 yes /44n Closest Mal. Wo: Body
Tom of
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Groin k vh
MAYAW
Bued+aar Rives ___ _.
an distance oKshme
mac distance oftwe
Basin. chuxni
cubk yards ___
Bost ramp
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Le"O t.lJD I -
SAY: not furs yes V
moragolun G yes no
vhow, e no
vVairer AtradwNk Yes
A buck permit mai' be required by;
( Note Coal Pia wft Jtsdaim)
Notast sp"W CmCklona
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21 A ifi+ravw, --t
Sr�pcdre Pkme read nt on back of pow* -
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See note on back reWdbt River Bash riles.
PsrmkOaksrs Printed
Somure
ro(pa atic Dave

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 1 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
2
F�

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:
(Lot or Street #, Street or Road, City & County)
Agent's Name #�l�r-- Mailing Address:
Agent's phone #: � ?�CZ—1 A--7-I
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 descrintion or drawino with dimensions must be Provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
/f you have objections to what is being proposed, you mustnotify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of m s 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 notiried by Ceraried 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.)
� 9 _ 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro a ty Owner t ormation) (Adjacent Property Owner Information)
FID
Signature Signature*
Print or Type Name
g Address
.�� f'v 2�
City/StatelZip q
Telep onq Number / Email Address
Date
*Valid for one calendar year after signature*
PrintType Name
Marling Address
CitylState/Zi— I
762—Zc6 7:F) 19
Telephone Number / Email Address
Date*
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: Y I2p ! 11 51 Urri
Address of Property:
(Lot or Street #. Street or Road, City & County)
Agent's Name #: 4%( ,� /� Mailing Address:
Agent's phone #:
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 proposers, ynu 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 notifred 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 Owpj+ Information)
mature
8t"IA
Print or Type Name
( j to ' t_-.�t��� �
Mailing Address
�1>
City/State ip
_,q 1.9 -/?n 1
Tefephone Number / Email Address
D t) W � , 7A 2,1
'Valid for one calendar year after signature'
(Ad acent Property Owner Information)
itgnature
Print or Type Name
Mailing Address
City/StatelZip —7
Telephone Number / Email Address
tTvNW, � t 7A z C
Date
Revised Jan. 2017

t7xx t�-, Zvi-14'

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OVA cr -, ('40-r-les t jwl' 51,-m

This map is prepared
from data used for the
inventory of the real
property for tax
purposes. Primary
information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
consulted for verification
of the information
contained in this map.
104 Seatone LN
Manteo NC, 27954
Parcel: 016192002
Pin: 987120819394
Owners: Blum, Charles E -Primary
Owner
Blum, Jill C -Primary Owner
Building Value: $486,000
Land Value: $302,500
Misc Value: $11,300
Total Value: $799,800
a
Tax District: Manteo Out
Subdivision: Division Of Harry Thomas Et
UX
Lot BLK-Sec: Lot: B Blk: Sec:
Property Use: Residential
Building Type: Traditional
Year Built: 1995

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