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74822D - Norris
AGENT AUTHORIZATION FOR CANIA PERIWIT APPLICATION Name of Property Owner Requesting Permit: I/V i A u kt4 Mailing Address: Phone Number: Email Address: I certify that I have authorized F / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development:. ©i at my property located at 1 b in I't rx leK County. T s,g;� I furthermore certify that l 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 Information: Signatures / Print or Type Name oW r«r, Title ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I I hereby certify that I own property adjacent to 14 ` Il e, 44 H- /torn. s s (Name of PrEWrty Ow e ) property located at (0 Q /''& P.�"If c r SL' •� t G% G (Address, Lot, Block, Roady�etc.) on k5 C! „{I - 1 So, �iL Ta og,�; ) / eilc - 4) � , N.C. (Waterbody) I (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back 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.) g 4/ _ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Owner �4 Yture L (Adjacent Property Owner Information). -- Signature ^T'- r?- V Print o Type N e ADJACENT RIPARIAN PROPERTY OWNER STATEMENT �7�7 I hereby certify that I own property adjacent to k, I I 0; tfi 1ya'r� I � t�"'/ s rr r1 (Name of Pr a Owner) property located at IM 0, A o r 4-A Q (Address, on Gr1►1,,I( , in. (Waterbody) etc.) n 1-1 - �`� , �d N.C. (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. _ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waiv 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 Owner Information) (Adjacent Property Owner Information) �k-- I' t-44-�— - S' re }} // gnature ��� ttclr 1Y- Alnrk-iS �1 L olwwl/a goW4?/V Prn or T pe Nam Print or Type Name tD 664 �?Yb ��� ��� Ch-k _ �JABJ e Coleman ael Keith Sutton many LLC hen & Laurie Cook hen Russ IV Properties LLC _ _,same rfruction Ann Sneeden itnt_ction Anthony Patterson Kurt Taylor Paul Maki same 3ck same istruction inc. William Norris III BB&T BB&T First Bank BB&T BB&T Bank of America USAA Federal Savings Bank FCB FCB First Bank BB&T BB&T State Employees CU 2435 $ 200.00 GP #75893D 5332 $ 200.00 GP #76599D 16997 $ 200.00 GP #76516D 13944 $ 200.00 GP #76573D 2434 $ 200.00 GP #76598D 1436 $ 200.00 GP #76428D 4831 $ 200.00 GP #76437D 5507 $ 20000 GP #76566D 5505 $ 200.00 GP #76563D 1305 $ 200.00 GP #76591D _ 7053 $ 400.00 GP #76585D 7044 $ 200.00 GP #76585D 2025 $ 200.00 GP #76584D - BB rct. 10220 iBB rct. 10222 BB rct. 10221 BB rct. 10217 BB rct. 10219 Ben rct. 10288 'Ben rct. 10287 KE rct. 10779 KE rct. 10780 PA rct. 10253 JD rct. 10815 JD rct. 10815 JD rct. 10814