79396A_Johnson, Steven & Upson, Karen_20210816

✓CAMA.,' DREDGE & FILL 7 Ti B C D
�JGENERAL PERMIT Previous permit #
VNew Modification Complete Reissue Partial Reissue Date previous permit issued
As aiitnui ized by the Sine of North Carolina. Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
xtrwhed.
Applicant Name S+eVop, "30,^_t kW&,, (jp$07- Protect Location: County (r&r,*-ck.
Address 1`363 L-,,LA Street Address} State Road/ Lot #(s) IX3
City n tGk- State&C, zip 24193.
Phone* (,J6?)TO;L-A3 Tcl-E-Mad Subdivision
AuthonzedAgent city zip
Affected Cw VIEW 4TA ES PTS Phone # ( . .. ... River Basin
AEC(s): OFA HHF W UaA IWA Adj-VVtr- Body C<+4Zk SoL_, -A
L C-
ORW yes PNA yes (no
Type of Project! ActWky A,-,ft) %M4 j�
(ScaW.,A,,)TS
OW t&xk) terigui MW
Fixed fttfomi(s)
FIC-19 Platf—w Y alf, "tomi
ringer pains)
ButkheaW Riprap:eqw
an attarce aNhwe
�x dzEiince offshore oy I"r
fd
T
goat,amv 4
ow VIA, 'eA"e
Beach Bujkleong
"[her
C ix le zt
t ace IV
SAV -10tMire
no ijl..Ex c7ey
A `}uflding permit may be required by: - CL- +,i, S" note on back regarding River Basin rules.
: Noce I-ocal Planning Jurisd,,ticin),
Notes: Special Conditions
Agent ant Ismited Name ,t OHrcer s Pr ted N
signature Please read compliance statement on back of pet mit Signature
Check t Nsswnll Date. Expiration, Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: -76 1
Email Address:
r
i certify that I have authorized �'� Q��-' �� - �-'� �` C_
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining /all'CAMA p_e�rmit�s
necessary for the following proposed development: I-�*-�t�
1
at my property located at
in ro{ (*-County.
I furthermore certify that l 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 Flame
Title
Date
This certification is valid through ! I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL " RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: e vet O i� (eN WS of\ .
Address of Property: (l O n1 0c, 27T ZE
l
-� ((. j
Mailing Address of Owner _ A:� l721 West `'l e Gt
Owners email: eV - tKe 7 Owner's Phone#: 2-375
Agent's Name: & "t/J-`1wl i✓t�,", t iAgent Phone#: � � Z
Agent's Email: ef-tq A O- l(_l t t > of 0 ©i1S t6D tntt - (\t -
V
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
'Bottom portion to be completed by the Adjacent Property O•xner)
1-;tw ° I hereby certify that I own property adjacentto the above referenced property. The individual applying for this
1 permit has abed to me, as shown on the attached drawing, the development they are proposing. A
(nrr' r- descriotiorv6r drawing with dimensions must be provided with this letter.
t �Y" f
i DO NOT have objections to tnis proposal. I DO have objections to this proposal
ff you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. GWIn St, Ste. 300, EH2abeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or dprap revetments ou wi h to waive the setback, you musti n
the appropriate blank below)
100 wish to waive someiali of the 15' set ck
-OR-
Signature of Adjacent Riparian ProWrty Owner
I do not wish to waive the 15' setback requirement the blank)
Signature of Adacert Riparian
Typed/Printed name of ARPO: 45e7 -tf'( ' ,
Mailing Address ofARPO: �101', Oi.r) 1�fts�i I€ C�, J ��"� ✓rc uci� � 7 � f claz
ARPO's email: ab pin �x i#ont1F �wir/A 4Rt56 s P ne#:
Date: 01 A "waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

Or
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cc
Emanuelson & Dad, Inc.
PO Box 448
Nags Head, NC 27959
Phone: [phone]
Fax: [phone]
Email: emanuelson6705(422outlook.com
07/20/2021
Robert Rainey,
982 Old Huntingdon Pike,
Huntingdon Valley. Pa 19006-8354
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Re: 1363 Waterlily Road, Coinjock, NC 27923 — S. Johnston
We have been requested by the above property owner to do the following work:
1. Install 4 — 8" x 25' boatlift poles and boatlift.
In order for us to obtain the Cama permit for this project. Cama (Coastal Area Management) requires
each adjacent property owner to be notified. We would ask that you sign the attached form and return it to
us as soon as you can. You may scan and email, fax or simply mail. We are also attaching a sketch of the
proposed project. If you have any questions, please do not hesitate to contact us. If you do have any
objections to the proposed work, you may contact Cama at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely,
Jacqueline O. Lewis
Emanuelson & dad Inc.
■ Primt yNAtanie and address on ttte reveres
so that we can return the card to you,
• Attach this card to the back of the maiilplece,
or on the front It space pennes,
1. Articb Ptld�eed tm
.)(4hw6k A.
t� 4MI40b- 3S
Ilia 11111101Illl1101111it1111I!IIII�
9590 9402 6133 0209 1056 64
7018 1130 0001 7767 1381
._....... .
PS Form 3811, Jldy 2015 PSN 7530-02-000-9053
0 Agent
It YES, Hoer deRvery addrew beloW., ❑ No
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Emanue{son & Dad, Inc.
PO Box 448
r`
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Nags Head, NC 27959
,A
Phone. [phone]
a
Fax: [phone]
0
Email: emanuelson6705&outlook.com
O
07/20/2021
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Tony & Katherine Bell,
1359 Waterlily Road,
Coinjock, NC 27923
iRladMWFOO 5. rwor aac.m,.l�
❑�..e.�.+ '—
pnwmnm+a+q ter.
--� 07/22/2021
.UU i
Re: 1363 Waterlily Road, Coinjock, NC 27923 — S. Johnston
We have been requested by the above property owner to do the following work!
1. Install 4 — 8° x 25' boatlift poles and boatlift.
In order for us to obtain the Cama permit for this project, Cama (Coastal Area Management) requires
each adjacent property owner to be notified. We would ask that you sign the attached form and return it to
us as soon as you can. You may scan and email. fax or simply mail. We are also attaching a sketch of the
proposed project. if you have any questions. please do not hesitate to contact us. If you do have any
objections to the proposed work, you may contact Cama at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely..
Jacqueline O. Lewis
Emanuelson & Dad Inc.
■ Complete items 1, 2, and 3.
r Print your name and address on the reverse
so that we can return the card to you.
—''Attach this card to the back of the mailplece,
or on the front if space permits.
>,A� Addr@s ,
�`1a-4e,(, tie -
Cc, �c,N(—
S. AeCeived M OlriYleA Nmrrel C. Date of Do
tl. is ack9eas drfterert trCn xein f? OYes
If YES, enter dewy address below: p hb
{lltlll�l111lill{III�I{11�{I{i{
sevica
Der`-Y
9590 9402 6133 02091056 95
ctasrr ~fWA%k*doer+ay
❑P.stum P4ndPtW
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❑ cofta on OOKe, t»tiicted De6Veryr ❑ Sgnanin±Ccs�%rmcecmTM
2. Arttde.NUmben (Transfe{_fr�mserrtce lal }
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7018 1130 0001 7767 1374
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PS Form 3611, 3uIy2015 P6rt 75ao-o2-o "05-3
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