Johnston, Otis

G CAMA / ❑ DREDGE & FILL No. 75970
9,,.tho
A B C D
ENERAL PERMIT Previous permit#
New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of 9nvironmental Quality
and the oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
L I Rules attached:
Applicant Name j. _ ` I '' ` Project Location: County
(
Address j / Str a ss/ State Road/ Lot #(s)
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City_State ZIP
Phone # ( ' )
Authorized Agent _
Affected 0 CW
AEC(s): oOEA
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ORW: yes / no
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Phone # ( -) ') River Basin
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Agent or Applicant rintedted NaN Permit Officer's Printed Name
Signature Please read rr(e compliancestat nt back of permit" Signature
�/ y4l070
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _W /S J o h n s tnn n s
(Name of Property Owner)
property located at S _ C— n 3.j V / e t.a C.T .
(Address, Lot, Block, Road, etc,)
n i �rn The applican as described to me, as shown below, the development proposed at the above
) h;,r� location.
ave no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
�
O,✓J`0¢-cNl> c9�1, "t•a..P.'��" Q'%L�Y.�L��p�n•w, CjL.dY�WJ
r�m �nhs �or
WAIVER SECTION 1
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 19 from my area of riparian access unless waived by
�` , me. (if you wish t waive the setback, you must initial the appropriate blank below.)
'r, f/7firdo wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner
&5W
. 42
Date
'Valid for one calendar year after signature'
(Adjacent Property
G
Telephone umb r/email address
* (Revised Aug.2014))',J\•\Q QtaN��V°`J

ADJACENT RIPARIAN PROPERTY OWNER '1STATEMENT
I hereby certify that I own property adjacent to /S J m n n S Inn n s
(Name of Property Owner)
property located at
on
In
County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
harms location.
_Ll-� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
9 o ✓J Oz c �'L> o OC
5t-,J
�m GhS �oy,
WAIVER SECTION
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 unless waived by
�`o\ me. (If you wish to waive the setback, you must initial the appropriate blank below.)
t I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
.Qionnhn•a
or
Address
Telephone Number/email address
/a- G- 6toi�
Date
a�s�w
(Adjacent
lIPrroperttyOwner Information)
Pne..r�X/ G—Jlt'
or
I-6qp®�/
Mailing Address
-ULF-16-11 NC
Clt lstatelzip
rta--53g-35b
Te ephone Number/email address
is - :- 0749
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature'
DCM-t'A"D Ct TY

AMA / ❑DREDGE & FILL N? 69755 A B
NERAL PERMIT Previous permit#
e ❑Modification ❑Complete Reissue, �]Partlal Reissue Date previous per it issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an afea of envlronrflental concern pursuant to I SA NCAC
`rll I lesa c e .
Applicant Name j T Project Location: County f
Address r " Street AddrestIt I�teRpad�oft#(s) _ n n r� 1T��I
Phone # (_Mail
Sub ' on
Authorized Agent
4%/
CIAffected
El CW�W
yL�
2rRTA ❑ ES ❑ PTS
PhoneAEC(s): ABody
❑ OEA
HHF
4Ll IH\❑ UBA ❑ N/A
Adj. W
PWS:
ORW ye �
PNA
��
yes / Ro ' 1
Closest Mal. Wtr. Body
Type of Project/ Activity
Fixet
Float
Fingr
Groii
Bulkl
Basir
Boat
Boat
Beac
Otht
Shor
SAV
ZIP
(Scale:([A :�i )
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Phots: Yes
A building permit may be required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions/ _
❑ See note on back regarding River Basin rules.
on back

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