36829D - Johnson

CAMA/ 'DREDGE & FILL • k"cm
LIEN ERAL PERMIT Previous permit#
(New _Modification Complete Reissue ''Partial Reissue Date previous permit issued
•ized by the State of North Carolina,Department of Environment and Natural Resources 1�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 • 1 2 d U
Rules attached.
:Name )'e►,..-+till �o 1,r‘s'�.. Project Location: County O n s to W
Si ) / To`' )c <\t P 4• 42A Street Address/State Road/Lot#(s) Z.o 4- 3.S 7310
y, e '1-5 rp✓. State N c ZIP ?&1(, () 44 7 G (-1a d,,,,,'ck S h o rc S 'Dr
016) 3 21 - 63SSFax#( ) Subdivision L I'.U#ftAi Ck f1 ore 5
?d Agent City Eel e a d S /'C r✓7 ZIP 69.6
cw 4W ""gPTA ES ❑PTS Phone# 01 n )3 2-ri ' - River Basin w li:-/c
❑OEA ❑HHF E IH ❑UBA ❑N/A Adj.Wtr. Body r u/I t 'a C PC a I( nat /n
❑PWS: ❑FC: �- 1� ✓
res / �io PNA yes) no Crit.Hab. yes / no
Closest Maj.Wtr. Body cj 4 Cre E
Project/Activity p J e W F','e✓ 4 (1 -t I o a-!,.mac, do t
J (Scale:///'^`
"
k)length "' 1 L 4 1,./ I'd C
,$) 1 Z'i k g' �._ ' i I v I ' . ✓
gth a 1JDy Pe' -._ - 7 ..._ '
fiber 12`k 8 r'
I Riprap length _
distance offshore _
:_,___..- 1 h X:distance offshore /Da innel
c yards �A
P
1!9 -, a
, ,_.- -
e/Boatlift
Ildozing
I-- - -
-,
1 j
1 ! i ; t
Length qU — `.. V ��`L �..::.
A_ iir
)
not sure yes n pi._ ,Sy41
not sure yes n / /J q 4 PI / k a e1 1,v .( 1 K. s
4
im: n/a yes .r._.
yes o --' 5 �h U cS � / .
. 1_ k T
tached: yes o lr n ✓f eye/'IL / (i vt Ci i i
I TT
permit may be required by: d hS I 0 I../ CO 14 Y)-I Lt I I See note on back regarding River Basin rul

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GENERAT, PERAITT COM2 TE•R FORM
ppr i C_ N i N_=ME: k e ✓1 To li kt.S ar);A
DDIT O:r NAMES:
EC 1 oDESIG:CW ) (�� ��� S DET!,OP i:_G a Z- PROD DESC: - '
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'OR_K.: 676, 4 E L I 2.1
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ACTION -°IRATI ON
FILL REQUIR : 3/010` 6/ /1 J 09
Lek MAJOR DE ELREQ : /i /o / Jay

ADJACENT PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ,ke'inieiiii ,Z; ilw o-, 's
(Name Of Property owner)
property located at Zed'35 61ct.k.R cliarlatik.,J 47 arida r'cik. •V Dr:,
r (Lot, Block, Road, etc.)
on ,JIL Cf_ , in silauk ryy ,N.C.
They have described to me as shown below, the development they are proposing at that
location, and , I have no objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED
DEVELOPMENT
(To be filled in by individual proposing development)
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Signature of jacent Owner
h edi t i i yX-7: OGf. '-t
Print or Type Name
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eb 23 04 10: 04a EASTWOOD CARE CTR 781 320 0314 p. 2
•
ADJACENT PROPERTY OWNER 5TA,TE ,NT
1 hereby certify that 1 own property adjacent to
(Name Of Property owner) —
pruperty located nt.z.L,- ,•.,L ' �.;. _
,JG. � r•
(Lot,131ockc,Road,etc.) �� �`"
They have described to me as shown below, the development they are proposing at that
location, and , 1 have no objectiotiS to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED
DEVELOPMENT
(To be filled in by individual proposing development)
P/o/ -s).t F,.e.r-
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Signature of A.dj;tcent Owne..- I s'-:=____1-
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Print or Type Name
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mil- rz,:5-y-
Telephone Number

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