Johnson, Leonard Alvis 80411C

Emailing: Image (185).jpg
CAMA / ❑ DREDGE • FILL NY 801 It A R D
ENERAL PERMIT Previous permit#
New ' ElModification ❑Complete Reissue - Partial Reissue Date previous p mit sued
Asaut zed by the sum of North Carolina, Department of Environmental Quality Q�
and thb Coastal rcas Commission an7of environme conom pursuantto lSA NCAC
(1 �nt k, aeu
Applicant Nam V' _ Pro Lowtlon: County
Add, _ - - — Street
CI ... State _ P _ Er+►fL,"7s .,Q -
Authorized Agent_•
Affected DCW T EW a DES , P Phone# ._,J
AECs: 0OFAA HHF IN ❑UBA L; 1(/�j,,
O / C:Pws: Adj. Wtr. Bod
ORW: ryp / po PHA yes I Closest Maj. Wti
Type of Project/ Activity_ Ill tNt_ .]l✓%/DI///-- A�1
Pier (dock) length___. -
Fiacd Pladorm(,)
Fl=ing 1) ' -
Groin length-- -1 -�
rumba-
BulMh n dleprap h - l f�
a ognro oasoffdhoro
mex danen ce a%sho
elk —
Baer p
aNc yore, 11 a � et
ram _ A_
r
Bomhouse/Boadift •�- ....
-- -
BearhBWldeslniii
Other - �- '----
l r
Shoreline Length
SAY: notsun
Monnodum: Na yes
Photos: yes no I f I ! )
Waher Atuched:Y.
A building permit may be req d by.. • ❑ See note on hack r9gr
(Note Loot PlanningJudsdiction) /� (; A
Fees)
mgnawre .
lu Dat '
2 of 3 5/24/2021, 11:09 AM

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: e , V i A�
Mailing Address 54 S ire✓ �t e.l JJ .
Cla
Phone Number: 9I O - IV?
Email Address:
I certify that I have authorized % Oil 6 ��� AgdrA C Cractor
Ag !Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
4�ti of e, i64 bocci
at my property located at 54S l�cV �c�LCI� ��.
in i aee.e-t County.
I furthermore certify that I am authorized to grant, and do in fact grant permissioi
Division of Coastal Management staff, the Local Permit Officer and their agents to a
on the aforementioned lands in connection with evaluating information related to
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
y lei lair
Date
This certification is valid through ± l •�L r 1 J �

I hereby certify that I own property adjacent to eon Qv C/ i
(Name of
property located at
t^M V vva
on Le Crce-l� , in
(Waterbody)
e
and/or County)
The applicant has described to me, as shown below, the development proposed at the a
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must an in desedpilm below or attach a site draw
J �
- -- — L,d I — U t'-I —
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
must be set back a minimum distance of 15' from my area of riparian access unless waiv(
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
eonc' <"( /'tiv"s ,�c/Ua6 or' .. �10 /z /V ),
d or Type Name Print r Ty Nam
A��/lU) fir -�
ping Address AfC 2 e S 8 `/ (_'P/ '— ("0�✓t t� 61
/S atealp City/ tale fi y G n
whore Number/email address Telephone tfumber/email address
I-21-2f
Date
(Revised Aun.

I hereby certify that I own property adjacent to _ 2cn « c/ V _ __ /�. % �s •?
(Name of Property Owner)
property located at 5 .. %�� ey C�,-c rlc (�Vi`
(Address, Lot, lock, Road, etc.)
an
(y'dat'erbooly) (Gift/Town andlor Gountvt
-The applicant has described to me, as shown below, the development proposed at the a
location.
I have no objection to this proposal.
I have objections to this proposal.
Yv Yrn DESCRIPTION ANDIOR DRAWING OF PROPOSIED tDIEVE,t..OPMEN
012ati°l,r8n AM'' ximposing dfevehnment must M In dencripflon IWovv rar &X atria c SHO tree
411.
°.
c I a r I. ire
iltfAiWER tMC-11 MA
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
must be set back a minimum distance of 15' from my area of riparian access unless waive
me. (if you witch to waive the setback, you must Initial the appropriate blank below.'
i do wish to wave the 15' setkittrl< racltaire,ment.
i do not wish to waive the 15' setback requirerrrent.
(Property Owner Irrhxrrraptiun} {Ad vent Propwrtgr Owner la-aforrpaatic
v
Al
Date
,`Rsvi,;ed Afnr.
i'