Johnson, Emmit

�7�C�A11/�q /wCJ DREDGE & FILL /` ' , ' `? No. 75254 �
A B l.i� D
GNERAL PERMIT Previous permit#
/Ngv ❑Modification ❑Complete Reissue " ❑Partial Reissue Date previous permit issued
As a�[horized by the State of North Carolina, Department of Environmental Quality —/ry/C1 _i
' and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / / L,'i
- // i El Rues attached.
Applicant Name d� /� 1' i� / I c%' ^ Project Location: County r "
City () ''` State Al ( zip
,
Phone # (•'`) (% ' % .��, E-Mail
AuthorizedAgent�t isr' e'^tl'"''
Affected T"CW ❑EW' O'e TA ❑ES ❑PTS
AEC(s): 71 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes_ / no
Street Addres¢/ State Road/ Lot #(s)
Subdivision
City 1 r ZIP,.=
Phone # ( ) (� River Basin_
Adj. Wtr. Body l �+ ' gnat'/man /unkn)
Closest Mai. Wtr. Body '.. / ` 1
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MEMO
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit**
Application Fee(s) Check #
Permit0(fcer's Printed Name ,
�.. Signature,
Issuin Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: L".4411A,;* A -
Mailing Address:
Phone Number:
Email Address: <✓h crc o ,t a % p Cam
I certify that I have authorized To7 7.3
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
NrN41 C&(--� ice/- 1. 81X2y,(t
at my property located at 2.2 / j'T�,� i fs �r �jto t /$, /�cK ; Arb rr /a;at�
in CA-y'}ereI- County.
l 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 Information: RECEIVED
Signature ®CM MHD CITY
Print or Type Name
Title
7 I G , zolq
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L- m -% i -H A �'To tins 0"L- 's
(Name of i Proper Owner)
property located at >2 Z 1 S%�!) i75' �' ( /-O r•" /�� AU-i- /f46ar Fb;1t1)
(Address, Lot, Block, Road, etc.)
on S f'r/1 l l S in %Reed ✓l� C A-V- V e re N.C.
(Waterbody) (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.
___ --- - -- —--_-LLa\Le_objQtQti_ons to this_pr_oposal . ----_.._-...-_.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
ft � � l /� c e ✓s or rti t r c( o c r at 4 wA A-geg b y # vri c ,-�-mc F eovt-ck
Bh. ,4.aw..2 TU D t�Y! 6Lf
91 �f woH\�.
8 x a '� flt
j C't
4�. '2 (Z++ck c I'x G{
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 %y2tiniW 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)
Signature
C- A4M d H, foil aS'Oku
Print or Type Name
Mailing Address
City/State/Zip
'�33 - S0�-�6D
Telephone Number
7-6 - /9
Date
Scent Property Owner Information)
zture rr�
o�' e0lNa 1e_I_ I . h -� C '
Number
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Eve. ' H H, J 0 ti s
(Name of Property Owner)
property located at ZZ / STRAi Ts DJ (lot—l8 _ /-&O'L Ir
(Address, Lot, Block, Road, etc.
on%�/J I TS , in 1�ef�ccFaa?' GA ✓�er�e f N.C.
(Waterbody) (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.
Ihav_o_objactionsAothis_pr_oposaL.._____.__._-___
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Aep)a-tee ,fore.. doz%�— �� d� ,cvvu� e•/©�^^�_
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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' ' ' I the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback
(Property Owner Information)
Signg(ure
Print or Type Name
2- z l ST-' n-; Ts' Dr
Mailing Address
x e 4i t- fo
city/state/Zip
,2g - 5614 -2, 0
Telephone Number
7 —d -/ 9
Date
Date
(Revised 611812012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Z Nt JJ h wS 0 's
(Name of Property Owner)
property located at SrRAirS Dry, /3QAwfa✓fiNC. /of AB , fffvei ?F IIAY r �i�
(Address, Lot, Block, Road, etc.)
on Cn-na) vIf A J'r%*_.fs in Carf.eYeI— , N.C.
(Waterbody) (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.
this -pro pas aL_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description
description below or attach a site drawing)
/�§Plq-Cd 0 C K di#-V' +('� fY AuYvr-LA-K0 jt/a YeklcF
ove-v- dfi prr'K!
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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
wis to w e the setback, you must initial the appropriate blank below.)
I d oo wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback
(Property Owner Ir
Signature Si
L/"K1i� ,TJ NS d/'L
Print or Type Name Print
Zng Address Mailir
4tifu_AA
City/state/Zip Cito%
�5� - 50—�GU3
Telephone Number Tele,
8-/3-/9 A
Date Date
(Revised 611812012)