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Home My WebLink About78186A_Johnson, James & Amy_20210429cCv N CAMA / X DREDGE & FILL GENERAL PERMIT XNew JModification LIComplete Reissue ❑Partial Reissue N° 78186 G B C D Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 1 ^ 4 the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 /'i ` all Gd . , Lant Name _11frVe's Ud Rules attached. 41, " �� _ Project Location: County G hewGtn Address 44 {2 C ('m\&J ( fin,}. F Street Address/ State Road/ Lot #(s) CitY� State__ ZIPJJ rf 3 Z btro+ Phone # (16Z) $Cyio " M8 E-Mail Authorized Agent OCQcL,r►zjAy- �ri�i-a.c 6—, /�k, K { 54, Affected Cl CW ❑ EW )KPTA ❑ ES p M AEC(s): D oEA O HHF 0 IH O USA ❑ N/A ❑ PWS: ORW: yes / r� PNA yes /(9 Subdivision City Cotf nAor, ZIP aZ 9 SZ.. _..._ Phone # (=) _-- River Basin PA,3:e 14o�e w iC Adj.Wtr. Body "Er/� Cre ..il t man /unkn) Closest Maj. Wtr. Body_.....-AJ 64NIC(e_ S_14�J' Type of Project/ Activity kM1Q - i Zi 2- N)*Ii`> '91%6P0J Z( in 9154 t- f'x3 . Pier (dock) lerinh (Scale: I Fixes Float Fine Groh Boot Bead Bead Odte Shon SAV: Mon Phoa wale H■.O■■■■■■ witmo%'1!1. ...■■■■■■ MEMOH%0MMIMMMNMNMMM "* 11 lli�UNEii3liti■■ME■■MMEMBAN■ M�MEM■=MEMO==S MEME.iIiMMq •■ ■ ■ ' ' • go NO■■ ■MMM/Ai 1E■ ■■�� I ■HOME■ .■m■■■■■■i t■■■■�..■■ME OEMr■M MMN■■■■■■M. ■EMMEMEMMEN■MME■MMEME ME■...E■�MO.■MM■E■E■uE■.■E■■■■►q■■ MEEMMOEMOOM■■r■ME■■MENONE rEE■MNONE MC��ME ■M■M■M■■.MrMOM■N.■■OMEOMM■ M ■wtil�■E i ��ii�Mi■E■�.EM■EE■M.Eq � Ma�ME �M..MM■■ ■ME■MM■MORE 11■■rMOO ONE ME MHEMME 9 OEM N M■MEMM ■! ■ i — ME ME AMEPIMENIMMEMMORNMEM it MEMEN : i ■ � 51 ON ■ ■ 7.4►W- � �E�mmum IMIMGN■E■ ■ I MEMO® ■■MME MI■M EM I A building permit may be required by: C-6SA20AS `cyl•y ❑ See note on beck regarding River Basin rules. ( Note Local Planning jurisdiction) Notes/ Spedal Conditions It or Applicant Printed Nami Slgnatu Please read compliance statement on back of permit'* Application Fee(s) Check # �� Permit0 r' Printed Name Signatur �! lacl Issuing Date Expiratlon Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: G4AIM Mailing Address: -IP Phone Number: Email Address: I certify that I have authorized a Cadmlyt4l � Agent l Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: L1- 51 \ f I r'..o I— n I/L — J at my property located at IL in QILW on County. l furthermore certify that / 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: i ure lames , Uoln otn Print or Type Name Title / J Date This certification is valid through J JACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ) ✓ v 's L.J (N me of o rt Owner) property located at h a - (Address, Lot Block, Road, etc.) on n _, in ��kv 'yy"� , N.C. (Waterbod (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location_./ x/ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT Of7dlvldual proposing development, must fill in description below or attach a site drawf tgj a8 LF" 5149, bahlod, WAIVER SECTION I 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 wish 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. (Propert Owner Information) (Adjacent Pro elty Owner Information) nature Si nature Print or Type Na e �'nh f'L Pri t or Type Name L Ia - - � nn cu -nn ra,� �5 M Ii g A dres Mailing A dress r f�r, 1� C a 19 1 ��xr— . tjc- 0--rQ ;�, City/State/Zip City/State2ip Telephone Number/email address Telephone Number/email address Date Date' 'Valid for one calendar year after signature" (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Fl% I I)IIU ',1110" 's N Property Owner) property located at (Addfess, Lot, Block, Road, etc.) on �o _, in Ckn CA.�,= Ln , N.C. (Waterb(@y) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (/nd uat P�F�to develop»e»t must istt in description below or attach a site drawlntg) a& LF d s/ a a' uq 6-4-Uh,A WAIVER SECTION I 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 wish 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. (Propert er Information) re J� �r1 Print or Tye N mp T Co�t1W -F(-0 toMai ing ddress n �z �) --(A.� CitylStatelZIp Telephone Number/ email address Date 'Valid for one calendar year after signature' (Adjacent Pro Owner fo ation) sti�1afv)I , r > it irl l ort'� oe I�iLl�InWl ilipg A dress kc Z9 3 a City/�State2ip Telephone Number / email address Dale' (Revised Aug. 2014) f ..jww—fAEAbdhIwiAM `1�2 Untitled Map Write a description for your map. Legend 113 Pembroke Cir tx xv J. o o 0, ,4t y' 8.5 "1, . r '5 PEMBROKE.l'IR 95.10 GCS' �QSEME'NT dim e ,3 Ik -� Ik d 516,1 C Y cth� � �� \�' s'��