Johnston, Fletcher

DREDGE& FILL No. 75250 A B C D
7EERAL PERMIT Previous permit#
1Nve❑Modification Ll Complete Reissue ❑Partial Reissue Date revi us permit issued
As authorized by the State of North Carolina, Department of Environment` [ Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC l
! / _rl Rules attached
Applicant Name Project Location: County ( -
Address)Street Address/ State Road/ Lot #(s)
City— State ZIP
Phone # ( ) E-Mail Subdivision ' f "
Authorized Agent City((� ZIP
❑CW ❑EW ❑PTA ES ❑PTS Phone# River Basin
// \ /unkn
Affected OEA ❑ HHF ❑ IH UBA ❑ N/A fhan
AEC(s): ❑ Pws: � Adj. Wtr. Body (nat /� )
ORW: yes / no PNA yes / no
I Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
pu ber
Bulkhead/ Itiprap length
avg distance offshore
max distance offshon
Basin, channel \
cubic
Boat ramp
Boathouse/
Beach
Other
Shoreline Length,- /L_
SAV: notsure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes o
A building permit may be required by: Ll
\: l_
( Note Local Planning jurisdiction) p {{ --
Notes/Special] Conditions
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
I
See note on back regarding River Basin
CY
Permit Officer's Printed Name
Signature
Application Fee(s) Check# Issuing Date
Expiration

ADJACENT RIPARIAN PROPERTY OVINER STATEMENT'
(FOR A PIER/N100RING PILINGSIBOATLIFFIBOATHOIISE)
I hereby certify that I own property adjacent to
property located at
��7 eL2 No Lsl n 's
(Name of Property Owner) a a a.. C i\ a n n eA \J-. ', w C �- , Co Q,e. C a V e ('
(Lot, Black, Road, etc.) /� C I , /�
on �O U So in Cady',2 l.C� H )% el)o- oc
(W rbody) (Town and/or County) .
5
N.C.
He has described to me, as shown below, the developmeint he is proposing at that location,
and, I have na objections to his proposal. I understand that a pier/mooring
pilings/boatliNboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I dp not wish to waive the setback requirement.
I & wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
1
�D pad- 1�
-� /n L s '/ u j rZ-0
Print or Type Name
RECEIVED A I D 3 g a -�� 7�/
AUG 19 2019 Telephone Number
pCM-
MHD CITY Date:
f'Z/

ADJACENT RIPARIAN PROPERTY ONVNER STATEMENT
(FOR A PIERINIOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 'Tee Y'Ciy 'S
(dame of Property Owner)
property located at a J 2, CA a h n . I Vez L0
//11 (Lot, Block, Road, etc.)
on IJau Sawn inCcL 1Q Cei r (` N.C.
(WaMerbody) (Town and/or County) . -L tf S
Fie has described to me, as shown below, the development he is proposing at that location,
and, I have no. objections to his proposal. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I not wish to waive the setback requirement.
I da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
I�
A, 0 C��S�eC{
Signature
j% +-T � Z-� d � %tti/✓�
Print or Type Name
Name
RECEIVED ( /,) Y< �2 � y
Telephone Num er
AUG 19 2019
Date: _
DCM-MHD CITY

Au€.21.20'4 1:26PM No.4184 P. 1
©T,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael P. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Dat 4—�--24—
Applicant Name
Mailing Address <� Z 7' '
I certify that I have authorized (agent) , x to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct
at (location) sww 7-
40o Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Intemet: www.nccoastalmanagement.net
An EQual Opportunity \ Allirmative Action Employer - 50% Recycled 110% Post Consumer Paper