87200A - Bunch, Gretchen

a°��`4❑CAMA ❑DREDGE & FILL N9 87200 A B C D
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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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc. ov/CAMArules
Applicant Name t Authorized Agent
Address . i `'l Project Location (County):
City (-( [ O (l , - State - ZIP - i Street Address/State Road/Lot #(s) G.. ( i3
Phone #
Email Subdivision Cc) V Ct S/ 0'--
City C •-- zip 1 7j92--1
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wtr: Body �. i o-n a( '(-� �� Vs �` ( `� 1 'b!L f (natlunk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body {r p'::', V\ 7 T
ORW: yes/no PNA: yes/no 11
Type of Project/ Activity "t; h<i I G, %o rr, tz. x - ci r• (.� �' � `.
r
(Scale:
Shoreline Length.
Access Length _
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore-
Breakwater/Sill
Max distance/ length _
Basin; channel
Cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing
Other
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 n
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. (Pleaselnitial)
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ✓C I Ght Rrti�A
Mailing Address: t� d , ( f0� i3
�n✓o j1a ►' c 2'-1 -Z;%
Phone Number: UP o 'a — 0488
Email Address: 6
I certify that I have authorized I! %,QZ; ji KOH Thompson
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 219>i Sp'T'4 , r."a. rl c. 2"717-?
in Ctm44 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 evaluating information related to this
permit application.
Property Owner I rmation:
Signature
Print or Typ^ame
Title
3 !—'6 1 Z�X -
Date
This certification is valid through . / f

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)
Name of Property Owner. (�f�7'Cri•PYl I�/tCf
Address of Property:
Mailing Address of Owne
Owner's emailL;& l,_ o4n Owners Phone#:
Agent's Name: ( eG tG k� �1�c��t� Agent Phony Z:S'_ ZZo']—lo�
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom RgI[fon to be completed by the Ad)ecent Property Owner)
I hereby certify that I own property adjacent to the above referenced properly. The Individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. g
description or drawing with dimensions must be provided with this letter.
S I DO NOT have objections to this proposal. I DO have objections to this proposal.
n you nave oviecuons to wnar is oemg prepozeo, you must twiny me ff— urvrsrun v, a.vasa ,
Management (DC60 In writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. GdMa St., Ste. 300, Elizabeth City, NC, 2"09. DCM representatives can also be
contacted at (252) 2"3901. No response is considered the some as no objection if you have been
nottfled by Certfied 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 dis3ance of 15' from my area of riparian access unless waived by me
Qhle does not apply to bulkheads or riprap revetments). (if you wish to waive the setback, yourmuststan
the;appropdate blank below.) : s
I,DO wish to waive somelall of the 15' setback 51(
Signatu of Adjacent RiparianProperty Owner
M
lilb iiof rish to waive the IV setback requirement (initial the blank)
;Signature of Adjacent Riparian Property Owner:
TV-9diPrinted name of ARPO; & �?� Z4 _0 AVPA k-0-
Mailing Address ofARPO: V2L a��r
ARPO's email' - =. ARPO'e Pnonat«: '� �CSS 3OV
Date: _'waiver is valid for up to one year from ARPO's Signature"
Reirlsed July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner- _—
Address of Property:
Mailing Address of Owner
Owner's email:Owner's Phane#:
Agent's Name Agent Phone# _
Agent's Email.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
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 tin or drawing. with dimensions must be provided wi h 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 proposea, you must noury roe rm- wrwsrvn Ur r.vasl+n
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 [phone]. 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, Book, 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 somelall of the 15' setback
Signature of Adjacent Ripartan Property Owner
M
I`do not wish to waive the 15' setback requirement (in#ial the
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
c-e. L L C,
MailingAddressofARPO: 02
ARPO'semail•9?:1U A4sS$LAf-'0MARPO'sPhone#: '"tS 1^26-7"SS'3
Date: 5 -Q-6 ' 2�5 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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