74247D - Johnson

LAMA / Cl DREDGE & FILL No. 74247 A B C (g
GENERAL PERMIT Previous permit#
New ❑Modifiication ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 69114. 1200
❑ Rules attached.
Applicant Name RuG1LY &�_c AAMu w/ , r A^j4a At
Address :F) 15 O(ATrmyLuny D Iotty• Y_
City 9W,4c%.► State A(C ZIP,Z9 468
Phone # [phone] E-Mail '~Aon OSAVAI+ss. con
Authorized Agent JV 1A
Project Location: County WICK
Street Address/ State Road/ Lot #(s)
Subdivision G
City ZIP
Affected )(CW )(Ew XPTA ❑ ES ❑ PTS Phone # (") y4 3- 5 ► OS River Basin
L-wAls e-L
AEC s : ❑OEA ❑HHF ❑IH ❑ UBA El N/A Adj. Wtr. Body CREEK oFF A(WWn/man /unkn)
❑ PWS.
.. ., L 1 W W
'�t0 /A ,n
or Applidan nted e
o
pQi
Signature *"` P16se read compliance statement on back of permit"
200 _-4,ZO'TS
Application Fee(s) Check #
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Permit Officer's
-PPriinteed Name �(
/uft / VC
Signature
5 ISP42of 9 9 8 Zo19
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: "40C f 7101,ins.on
Mailing Address: 3) 3 jai o,+*z� v j o,
Phone Number: 10 - 5°j9 - 0(093 ql9- 7G3-S)a5
Email Address: Gn nQ �► S ,Q �,� a h �o , CPm
1 certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development. j3 v '� ld "g ar
_17:>►ec , l OX l2 dnc-L W t 1 zL `N 10 ck cK
at my property located at 313 ljJ o, U r, 5 tJ 3'1 n S e L tk cc 6,41t W�'
a.9 �f jai
B r Qr► s w "�_� 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 to this
permit application.
Property Owner Information:
S' nature
R oC.� cia� S 11
Print or Type Name
Q Wt er- a-F
Title
�l'R l-26i q
Date
This certification is valid through I I

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:3
(Lot or Street #, Stl•eet or Road, City & County)
5-4+
Agent's Name #: Mailing Address:
Agent's phone #:
I her, SENDER: COMPLETE THIS SECTION COMPLETE THIS vidual
apply. ment
they c • Complete items 1, 2, and 3. A. Signatt:oe
after.
■ Print your name and address on the reverse X ❑ Agent
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the mailpiece, 1B• Received by (Printed e) C. Date of Delivery
or on the front if space permits.
If YOU) 1. Article Addressed to: D. Is delivery address different from Rem 1? ❑ Yes )CM) in
Wridns � r t f t ` a [4-k -"Y 1� If YES, enter delivery address below: ❑ No
FFFF���� RECEIVED 'nse is
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❑,Adult Signature Restricted Delivery ❑ Registered Mail Restricted
wish t. 9590 9402 3923 8060 3049 54 ^K Certified Mail® Delivery
ertified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. Article Number Mrancfar r ...,, --.:-- • - . •• :ollect on Delivery Restricted Delivery ❑ Signature ConfirmationTM
—" 7 018 0680 0 001 4664 4 616 rsured Mail ❑ Signature Confirmation
sured Mail Restricted Delivery Restricted Delivery
(over $500)
T PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
(Property Owner Information)
- fi-b(/ -
Signature
'p- d sky -23a �,-, Sc
Print or T pe Name
313 W4+--kr I"Ieke Dirt SLA
Mailing Address
5u n5C-+ NC. 2$1( 8
City/Statellip
qlo- W- p QiIg3
Telephone Number
-1Z-I°I
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelLip
Telephone Number
Date
V
Revised 611812012

5/7/2019
USPS.com@ - USPS Tracking@ Results
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Tracking Number: 70180680000146644616
On Time
Expected Delivery on
MONDAY
15APRIL by
2019 p 8:00pmpp
OV Delivered
April 15, 2019 at 1:56 pm
Delivered, Left with Individual
GREENVILLE, NC 27834
Get Updates \/
Remove X
CD
CD
IL
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CD
X
https://tools.usps.com/go/TrackConfirmAction?tReHullpage&tLc=2&text28777=&tLabels=70180680000146644616%2C 1 /5

5/7/20.19
USPS.com@ - USPS Tracking@ Results
Text & Email Updates
Tracking History
April 15, 2019, 1:56 pm
Delivered, Left with Individual
GREENVILLE, NC 27834
Your item was delivered to an individual at the address at 1:56 pm on
April 15, 2019 in GREENVILLE, NC 27834.
April 15, 2019, 11:41 am
Out for Delivery
GREENVILLE, NC 27834
April 15, 2019, 11:31 am
Sorting Complete
GREENVILLE, NC 27834
April 15, 2019, 6:31 am
Arrived at Unit
GREENVILLE, NC 27834
April 15, 2019, 5:05 am
Departed USPS Regional Facility
ROCKY MOUNT NC DISTRIBUTION CENTER
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hftps://tools.usps.com/go/TrackConfirmAction?tRef=fulipage&tLc=2&text28777=&tLabels=70180680000146644616%2C 2/5

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: 6�n
Address of Property:
(Lot or Street #,
Agent's Name #:
Agent's phone #:
c.
,It t Jw
�— ...
or Road, City & County)
Mailing Address:
I hereby
applying 1: SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION DELIVERY
they are I • Complete items 1, 2, and 3. A. Signature
■ Print your name and address on the reverse
so that we can return the card to you. X —�
■ Attach this card to the back of the mailpiece, B. Receiv by (Printed Name) C.
or on the front if space permits.
1. Article Addressed to: +
If you IiBVf Q D. Is delivery address different from item
writing wii ^ F�Y1g2�d I��Mo' If YES
INlmingto,
consideret
I understi
back a m
wish to
, enter delivery address below.
Nc Da7 3 �;
p;vis: n i SSW}13nt'In.34 RECEIVED
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ified Mail® Delivery
rtified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. Artinlw :)Ilect on Delivery Restricted Delivery ❑ Signature Conflrmationw
7 018 0680 0001 4664 4609 cured Mail ❑ Signature Confirmation
ured Mail Restricted Delivery Restricted Delivery
(over $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
(Property Owner Information)
Signature
Q d �kc, �a-�n
Print or The Name
313 Wo+-krIAku Dir, SLI
Mailing Address r
5u nse-+ L-ack-)I NL 2-S'Pe g
City/State2ip
Telephone Number
Date
jai
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in
A,
is
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
11V
Revised 61I M012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED I REcE vED
APK 1 2019
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORMC DOT
DISTRICT 3
Name of Property Owner: on Oct (/ �,S pn
Address of Property: 313 Lac. ag y V
Agent's Name #:
Agent's phone #:
(Lot or Street #, S6eet or Road, City & County)
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
A-�/_
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
— fl,9/
Signature
1 0k -C%tirsco
Print or The Name
313 W 4f--r
Mailing Address
.sunset (�tct ck)t Nc 2 T12
City/State/Zip
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
1v C,& Cyr300
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Mailing Address
City/StatelZip W
(91b) 30, AJ W
Telephone Number U
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Date
Revised 611812012
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Rc u � .7 ')S�on
Mailing Address: 3) 3 1 v aj--r- v j o, 17r. SvJ
StJ„st. -- 8t-,c�1 aN(- a8`Ib8
Phone Number: �i Id - 599 - Ob�d3 919- �G3-SIDS
Email Address: 16 S "000 , Cpn
1 certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: T-1� v'%ld 1 /:3 a % ?, `i `f
P e-r , IDxl2 dna, wd4i n, LfYIo SheP doIja dock
at my property located at 313 yJe ter Wo V Dr, S tJ y NC.
-9 `f t
in o�
T3eg,, sw,c.KCounty.
I 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 to this
permit application.
Property Owner Information:
MCA,
S" nature
RoCkli rio�h Snn
Print or Type Name
(� WO CC a-(- D(n
Title
Hl 9 t2.niq
Date
This certification is valid through I I
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