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Home My WebLink About71780D - Johnson)Y `12 Vl�,11 AMA / ❑DREDGE &FILL N�J17SOA B C D ` ENERAL PERMIT Previous permit# ew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As a� orized by fhe State of North Carolina, Department of Environmental Quality (ZOO a the Coastal Resources Commission in an area ,o�fenvironmental concern pursuant to I SA NCAC � gales attached. Applicant Name �U1`i 1J E �� AU Sd (J Project Location: County S i D W Address-}� A -2- V I�.� i� j � 6- AU � �� • Street Address/ State Road/ Lots#,(ems)( { City i 1� State NC. zip zS Phone #`T�) —2201E-Mail Subdivision ' Authorized Agent h LAC i C 1�14AA-1 City ZIP ,�/2.�`�� ❑ CW � XPTA ❑ ES ❑ PTS Phone # ( River Basin %v Y ��& Affected ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A AEC(s): Adj. Wtr. Body tyt S �' � �'" � man unkn ❑ PWS: V U tit Closest Maj. Wtr. Body ORW: yes / no PNA yes /(no) Type of Project/ Activity �S` (A 1 1 Pi Fi FI F G E E E (Scale: - 20 ) p ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�� ■■■■■■■■■■MO PAP ■■■■■■■■■o■■■■ ■■■■■■■■■i�L:■■L■®fit■■■C�■!■■■■■■■■■I■■■■ Q _ . ■■■■■■■MEN ■■■■■■■■■ONE 0■■■■■■■■■■■■■■■■■ No NONE ME ■�■S1■[U■■■■■■■■ ■■■�■■■■■■■■ ■■■■■■■■■ ■■IiJ■■ Him ■■■■■■■■■■■■■■■■ ONE ■■■■■■■ ■■■■■■■■■■■■■N■ ■■■■■■■■■■■■ MEN ■■■■ ■■■■■■■■■■■■■ ■■■■1■■■■■1■1■■■■■■I■■!!■■ ■■■■■■■■■■3iliih■■ONE■t■F1��1■1■■■■■�i�A11111111A�111■■ ■■■■■■■■■En 11111 ■.FEi11■s■�■I■1■■■i�j.y�111�J..i.�. �r� i ♦ r INN s1■■■ ONE ■w■■■!1► 11p Ills ■N■■■■■■■■■■ - �� ,►i L71■■■■■■■■r■■ill■► No ME ■■■■■■■■s== __=�_==�__�■■■■ 0I��■101■ mom ■ ■■■■■■ ■■s'■■■■■■■■s■I�■itil■��1■■■■■■■■■■■ l■ ■f! ■■■■I■■■■■■■■lil MMM1111■■■1■■■®■■■■■■■■ ■1�L1S MEL".lil MEN ■■■■■■■■■■■IIII■■■■1■s!■®f no SEE ■illy■■■■■I. Emil ■■i1■■■I ■s!■■■■■■■ MEN ■■■■■W■■■ ■■!■■15/ir�MIfdlrJ■■■■■ -'10reline LengthME es hotos: yes �► . . _. mom Il■■■■■■■■■■■r■■■■■■■■ ■■■■■■■■■■■■■�1■�IJ■■■■■■■■■■®■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■®■■_■■■■■■■■■■■■■■■■■■■■■■■■� ■maw. 2101'.��' ■■■■■■■■■■■■■■■■■■■■■■■■■■a■■■■ ■■■■■■■■ ■■■■■■■■■■■■■■■■■ ENO ■■■ L/ A building permit may be required by: `7 t) I C-1714 ( Note Local Planning jurisdiction) Notes/ Special Conditions sD .I 1A t`Agen or Applicant Printed NameWA PQvmigClfficer Signature "Please read complian tement on back of ermit *'* Sign a re �; -- � 4- Application ) .A h n _ . k # / Ix�rng Date 2 _7 ❑ See note on back regarding River Basin rules. 0 .-- 4 IAI-V S - 3o -I9 Expiration Date 1/ ti ❑CAMA / ❑ DREDGE & FILL N2 71 780 A B C GENERAL PERMIT Previous permit# �lew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality arld the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC tt 0 �,� .❑ �les attached. Applicant Name / �UN I nF b NSO Project Location: County KS C W Address (� �O �% li6- 1?U AJ j�_d • Street Address/ State Road/ Lot #(s) City t N State NC ZIP z� Phone #qq_) Tst- '220(E-Mail Subdivision ^,- Authorized Agent II f�'/�{1 L l_ L � City zip 12��,`Sod Affected ❑ Cw NfW kpTA ❑ ES ElPTS Phone # (�--'j River Basin V v gL ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A S V v AEC(s): ❑ PWS: Adj. Wtr. Body Ck S man unkn ORW: yes / no PNA yes / no Closest Maj. Wtr. Body v U'i ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■i■��■■■i■ii��ii■■ice■®�■�i■■■■ioi ' �ii�i■■ii■■iii��aiiiii■iiii��i�i�i■ice■■■ ■�■■■■■��■■■■■�■��■Ilia �1�■■��■��■ ■■■■■■■■111�■■■t1"�i11'•'■L!'9lii�■■■■■�ti■4iTl�''a�1�J■■■■ - >a v 1z l Applicant Printed Name Signature ** Please read complian tatement on back of permit** Application Check # o I5-30-19 Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ' o NYLi Q _ Mailing Address: Phone Number: Email Address: Vt"0117f kC.•t Pe Dt,i,,, NE I Y3s`/ I certify that I have authorized l ;r l ,,u b(L 1 Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development- 1 eck- at my property located at / t q k Z J f ? in �J1S�li: County. S- 1 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: r r-�, Signature Print or Type Name C w �► r Title / 2 2- Date This certification is valid through /, CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM I Name of Property Owner: Address of Property: 70`� - .C, r (L t or Street #, Street or Road, City & County) Agent's Name #: Agent's phone #: Mailing Address: I hereby certify that I own property adjacent to the above referenced property. The individual air this permit has described to me as shown on the attached drawing the development they a roposin . 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 (910) 796-7215. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand ghat a pier, dock, mooring pilings, biaakwater, boathouse, lift, or groin must be set back a gimum distance of 15' from my area of riparian access unless waived by me. (If you wish tb a the setback, you must initial the appropriate blank below.) i ------�do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. _ (V perty Owngr Information) N7ure _ — Priht or Type Name 19 ►), J�f,li� fit)'AA- Mailing Ad r ss ity/Sta erlip Telephone Number , -50-1.i Date (A " c nt P perty Owner Information) SigWtuf---e)/f , S Print or 01 T pd a f Mailing Address Revised 611812012 0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to NA�nS. Cl'lt-, r n�J nvl' 's (N me of P&perty wner) property located at S-f e v S (Address, L , Bloc oad, etc.) on Cnw-\ r� , in u- , N.C. (Waterbody) (City/T wn and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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) WAIVER SECTION 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 me. (If you to waive the setback, you must initial 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) 77 Siature C Print or T e Name "lea r+"' 5� � ailing Ass C1tyytlSttate2ip alU-Sl(o�`ai�D� rtacka�-L?3[:(�ua.lrrt�.c� Telephone Nu ber/email address �� Date (Adjacent Property Owner Information) u. S'g ure Print or Type Nam ,36r Mailitsq Ad glress 5-o,2yl City/Stat ,,, �� ,7 %3 7 Telephonene Number/email address ;� --W-"� Date* *Valid for one calendar year after signature" (Revised Aug. 2014) i off. 1 .I.le ed Dare De os/ted Check From (Name) Check Name of Permit Holder Vendor Check Number ' amount Permit NumbeflCOmmenf5 Receipt or Refund/Reallocated Column? Columnl Column3 ColumM Columns Column6 Column? Column8 Column9 1/3112019' Lighthouse Marine Construction/Dar I Ern Donnie Johnson Coastal Bank 8 Trust 2.4 200.00 GP #71780D JD rot. 6966D Dab Rece/wd Dab Dposftd Check From (Name Name of Pe —It Holder Vendor Check Number Check -- I P—If NumberAComments Receipt or Refund/RealMcated Columnl Columnt Column3 Columns Co." Column6 I Column? C /Ull.8 Column9 us Marine n/D hn C tal Bank & T�t rt 0