68071D - Johnson

M
Ul

i�cccly cu I "c;vUa11GU I 1` I Ulll I I GI Illlt IIVIUCI-
i,Numoer I amount I irumber/
3/2/2017
(frame)
JRW RDW
Corp. T/A
West Johnson & Kinlaw
Enterprises Enterprises (Walt
(rick West) Britt)
Comments
BB&T 1160 $200.00 GP 68071 D
SF rct. 3778

ABC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V,-sov-, 2, nV l-[aw
Date: 631 �/Z o (`7
Permit##: 6 7o"71--D
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp .
impact amount
(Applied for.
Disturbance
total includes
TOTAL FeetFamount)
any anticipatedon
restoration or
temp impacts)
Feet
ted final
nce.
s any
and/o
pact
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 171 Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 13 U ^'l)c�cl.w + ru 41)kj
Mailing Address:
Phone Number:
Email Address: lJT 1
I certify that I have authorized i c_ �L J�'�S I ��1(1`� l v -
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
l�
necessary for the following proposed development: I-)ep-1 il-- 4--/
at my property located at
in County.
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:
Signature
Print or Type Name
Tice
1,2 o
Date

{ CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: "t'�
Address of Property: -� 7
(Lot or Street #, Street or Road, City & County)
Agent's Name #: g
�� ; �J<_ (.. y Mailin Address:
f
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
.Ahey are proposing. A description or drawing with dimensions must be provided with this letter.
_ I have 0% -^gal. `+� _ I have objections to this proposal.
— if you have objec w S ie Division of Coastal Management
(DCM) in writing / M r J �d �" ict information for DCM offices is
0
available at htfip (el a �� � � � �t Y � (� sfin or by calling 1-888-4RCOAST.
No response is I e L �S been notified by Certified Mail.
lAe .sVk fl, n
I understand "`^' Op 'I �rest `L eakwater, boathouse, or lift must
be set back M r Ian cc�h�l`' an access unless waived by me. (if
you wish to )� �0 7 r ate blank below.)
love ' ✓ ?rcra �_:
pia L
I�
(Property Owner Informatt%...,
Signature
Print or Type Name
iuirement.
sari P ` e0ty Owner Information)
5-
Signature
Print or Type Name

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Jy:�.✓��.ti ��-✓L��l ,J�� �, ��,i-, �r S
Address of Property: -37 N c"i flop-,- C% ) '13
(Lot or Street #, Street or Road, City & County)
Agent's Name #: dL IJeS 1 Mailing Address:
Agent's phone #: ?D� "G �"-�% rolvC) I f3 tiC-
I hereby certify that 1 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
r.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.
i
---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. Contact information for DCM offices is
available at http://www.nccoastaimanagement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST.
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, boat ramp, breakwater, boathouse, or lift 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.)LL
I do wish to waive the 15' setback requirement.
I do not Jwish to waive the 15' s%eytback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
(Riparian Property Owner Information)
4Signature
iPrint or Type Name
Mailing Address