73681_Gerald & Susan Johnson_20190723

iCAMA / DREDGE & FILL
- GENERAL PERMIT
_ 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
Applicant Name 6crc, 1 � + S�'>r, . :101. Say-%
Address I J3
City CV..�-, )( Stated ZIP a1gk9
Phone # a,0 qot E-Mail
Authorized Agent 1/L/ �, re•� (� r h
Affected ❑ CW EW K PTA V ES PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
El PWS:
ORW: yes / PNA yes / no
No. 73681 B c D
Previous permit #
Date previous permit issued
LP Rules attached.
Project Location: County (1, + f . �., L k
Street Address/ State Road/ Lot #(s) 103
5rZ R 1 3G S I t tt i .`
Subdivision
CityZIP a�SJci
Phone # ( ) River Basin
Adj. Wtr. Body (`,, 1 a, Co.'i.L 1t f (nat )�unkn�
Closest Maj. Wtr. Body Ic
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THEN No 1111001
U%qn1 k- [3 (_ L.L.
Agent or Applicant -Printed Name
c� j
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Offic • ted Nam-,
gnature
"I/1");nIa J I I�' 1�19
Issuing Date Expiration Date

NC Division of Coastal Mgt- Habitat Impact Computer Sheet
Applicant: Dh✓►s�rf (y< ra
Date:
Permit #: 4 3 & �?i A
Describe belo',�t the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
S a,.
Dredge [I Fill' Both ❑ Other ElaL
(/
0v
ShO(,t �A4-
Dredge ❑ Fill Both ❑ Other ❑
•
Dredge ❑ Fill ❑ Both ❑ Other
00
(� W
Dredge ❑ Fill ❑ Both El Other
aL
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10

AGENT`"' AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _��/./.SBA/ dy1 /1%SC1'�V
Mailing Address: M -3 �
Phone Number:
Email Address:
I certify that I have authorizedW
Agent/ Contractor
Lo act on my behalf, for the -purpose of applying -for and obtaining all CAMA permits-
1.
necessary for the f(pllowing proposed development: e ff' ./. _ LL
at my roperty locE3ted at d e/ ti
in County.
1 furthermore certify that I 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,l to this
permit application.
Property Owner Information:
Title
This certification is; valid through
l\ ;

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
nauf i; �►i ,0-5 ell S J1'� �J✓, s
,m In 0CI
((Otltr=n antes Cuwnty)
a iliJ , ihr�es a3 rniit i ^^+ . as; SO-0 4., below; t� cEv ,nt¢r pit :��d aft the 'Xie
'turE4ron
—.� .1 have no objection to this proposal.
I have objections to this proposal.
(individual proposing development must fill in description below or attach a si drawing)
,
W� I UZ as, 0� I
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 ►x)esa. euaiv�ed, b-)&
me. (If you wish to waive the setback, you must initial the appropriate blank be4.
J do wish'to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Ownur WROT"OTM14 Gwmr Information)
Fruit or7ype "r'Varn/� // �� Prrrii ar T• r� ' "any
1USr'
,Trr tin • /�rCt�t!!� �r�` le-f �2
City/state2ip Crty/5tate'M
05 -2-IBA
T e02-
e Na rdxrl email adores Telephone Number emaii address
g� za�LQQl_LC1�fl �Zo�le Dine k � /�
I

-71firwil-
I am�fvw
property located CIL
Address
V ih,
N.C.
9 prnent;prapased at the above
I have no objection to this proposal.
I I
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSMIZIEVELOPMEW
#NAM-0h"P upoe- g - ping, 1 '1mmastWTwdimsaqphw 4whwzrANndb asite drawing}
C)kl-\ IQ) x 164gyrn
LA' UX4-L-J<d Cv-q-r
0" X-
H =densimall 00 a piiar, dhalk. nwan, 01fiqlp. Its tramm.. ibxmrittaa�r. itmoAdhouse. lift, or groin
mun( tL- wd bwk -a "WOMM tiabmm Cc 151cm, rRN WMv%f npvlal' !Q=M--- -'k- less % tM%('e'A hif
me. ((Ilff low Nwah 1b Maine *e SENEEK, law WM011 kawtOxe -aP0M;D0Me tbM= below.)
J do wish'to waive the 15' setback requirement.
I do not wish to waive the 15' setback requ
T
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(Revised Aug. 2014)