86391A - Johnson, Douglas & Christine

DCAMA El DREDGE& FILL N9 86391 A, B C D
fA 1)Previous permit
GENERAL PERMIT Date previous permit issued
ffNew n Modification [:]Complete Reissue [:]Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission In an area of environmental concern pursuant to:
1 SA NCAC Rules attached, General Permit Rules available at the following link: www.deq.nc.gov/CAMAruIes
Applicant Name
Authorized Agent -L,
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #
Email Subdivision
City 71P
Affected 11 CW DEW FIPTA D PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): F] OEA IIHA nUW [:]SPIMA PWS Closest Maj. Wtr, Body . ........ ..
ORW: yes1no, PNA: yes/no
Type of Project/ Activity _ilk- , -
(Scale:
Floating Platform(s)
Finger pier(s) _
Other
SAV observed: yes no'
Moratorium: n/ae yes no
Site Photos: ye3 no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: N, 411 TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
nSee note on back regarding River Basin rules
ElSee additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWEDCOMPLIANCESTATEMENT. (Please Initial)
Agent or Applicaq PRINTED Name Permit Officer's PRINTED Nanie
L
Signature "Please read compliance statement on back of Permit" Signature
Application Feels) Check #/MonOrder Issuing Date Expiration Date

Name of Property owmw Requesting Perrrt Oot45 (A 5 T. ishoi on �=
I cm* that t have authorized
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N.C. DIVISION OF COASTAL MANAGEMENT
MAY 1 2 2022 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
DCM-EC
(Top portion to be completed by owner or their agent)
Name of Property Owner: ill, !� IA -r -J 'A n1an la -
Address of Property:
t0% we -% l�il/
Mailing Address of Owner:
Owner's email: %6�,� Owner's Phone#: /,�o' Lt� Agent's Name: iT 0!nL�rf� XnC Agent Phone#:C>5D
Agent's Email: _4�7depn W1,0-311 e 42If
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 they are proposing. A
description or drawing with dimensions, must be provided with this letter.
ti/ I DO NOT have objections to this proposal. I DO have objections to this proposal.
If 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. Griffin St., Ste. 300, Elizabeth 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 riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback 4go6 t'�
Sign e o Adjacent Rip rian PropertyOwner
-OR- j6sep� /l�/ �� �{/1S n 1k/w-fey
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: �-05eph 4Lt 1�>r�S?7✓I / 21 �
Mailing Address of ARPO: 6 G/'a l-�L Or- e I�Supeakie.� V6 Z, 33 Z Z
��/Se� ARPO's emaiil:�1)MOI� 03M ARPO's Phone#: '7s / " 7 " 51�0
Date: s�(0/ Z0L Z *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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RECEIVEED
APR 1 8 1011
DCM-EC

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