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Home My WebLink About89182A - Johnson, Susan#�couzyLJ CiAIVIA ❑/DREDGE & FILL N9 89182 A B C D GENERAL PERMIT Date Previouspermit nV Date previous permit issued ❑New ❑Modification ❑ Complete Reissue ❑ Partial Reissue As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commisslon in an area of environmental concern pursuant to: I SA NCAC Rules attached. FiGeneral Permit Rules available at the following link: ~vdeq.nc goy/CAMArules <' r' iCA'- V%`i :i'Vt Authorized Agent Applicant Name J CA. `'i,''e,n.tb:. Ag _ Address IC;) �') T`l!_i (%n. rC.-:�}--.?1"lit':: Project Location (County): City t._ ItU_G"�; State ZIP ) fVl:j Street Address/State Road/Lot#(s) 11h S�h s;�:'i 1- rq. S'.<'- Phone # (_) Email Affected ❑ CW EEW ❑ PTA ❑ ES ❑ PTS AEC(s): ❑OEA ❑IHA ❑UW ❑$PIMA ❑PWS ORW: yes/no PNA: yes/no Type of Project/ Activity Chnrclinc I anoth 1 FI C' Subdivision City Adj.Wtr.Body (natjinan/unk) Closest Mal. Won Body C UV r t "1;" U C kl- i 0 LX.'yu:.4 (Scale:) Access Length :..iklength■ Pier Fixed ■� ■■ � ��mom � �■��k �E�EEEE Floating Platform(s) Finger pler(s) aria M ..... MEN .■� •■ 11 ■MEN IMEMEM ■E �® Eon MEMO NE�I� :EE�EEVEEEEEEEE :EEE :E:■1EEEE 0��Ev6�ma��' oo ■ ■ ■ ■ ■N■■d.' ■tiIN■H■■■■ ■■■■■N!E■■■ ■ .:.:P:9EEE=v-- c:E MEEENE EEC' n l■■ mom ■■■■■E■■■E ■ONE SOME ■■C4■■ ....�... ■■■■....C.■■■■■■...■■. ■■■■■■n ■■ ■ ■ ■■■■■■■■■■ ■ ■■■ .■.■■ ■.c■�■■i�■■■o.■■iiii■ A building permit/zoning permit may be required by: C_Urr1'+LI.(_-k COIA.KAi Permit Conditions Agent or Applicant PRINTED Name Signature *'Please read compliance statement on back of permit•* Application Feels) Check ft/Money Order ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back (Please MI Permit Officer's PRINTED Name II Signature I Issuing Date Ex iration bate AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit SG�i� . J�G'jG ✓Oh Mailing Address r � , c. z� Phone Number 25z� ZD7 7%5- Email Address: 7(��, o I certify that I have authorized //Cfr'/�t Agent i Contractor to act on my behalf, for the purpose of applying for and obtaining all CAAMA permits �% necessary for the following proposed development: at my property located at /10 in C'ao-, / (ck 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: Signature r c JGtS�r>7 .�0�9G1�af� Print or Type Name dzv»,-y True �� 0. t /3 tom_ Date This certification is valid through N.G, ONMION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICA71ON WANER FORM OERTIEIED MAIL • R9MRN oer+slPT RFnr tc �TED or hf�AD DELitrERY ('fop portion to be completed by Owner or their agent) Name of Property owner. _:5,1r /y Address of Propertyyio la�E 4 Maitng Address of Owner. lLz Npuoa� Owners lob5(9W-s Phone#: ;7 �- -9t(OS Agents Name:y/�%i1a`j LL Agent PhonaA.2Ea-PB2 - (}' a3 Agent's Email: L.S rrt• @� Tj GC�n-1 ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom oartian to 6e completed 6v the Retiacen PropeRy Owrrerl I hereby certfy, that I own Property adjaoertto the above referenced property. The individual applying for this Pernik has described to me, as shown on the attached drawing, the development they are proposing. Aj,p. tlon or drawin , witt df ust be Provided `s letter. _ kDp NOT have' objections to this proposal. i DO have objections to this proposal. sment (DW in wr'*W withip 10 days Of receipt of this node;& Correspondence shduid 4e to 401 S. GrMn St, We. WO, Elhabeth CRY, NC, 279M. 0CM representeaves can also be led all (254 28&=1. NO response is considered the sense as no obfeetion f(you have been WAIVER SECTION %lElM eg br on t understand Ihat any proposed Piet, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 16' from my area of riparian access unless waived by me (this does not apply to bulkheads or ricrac revetmentsl. (if you w)ah to waive the setback„ you must atop the appropriate blank below.) I DO wish to waive sometall of the 15' setback Signature of Adjacent Riparian Property Owner -OR: I DO NOT wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: l fV"QAX,'l-/.�' }-'/Zt�rw•rv�- TypwWrinted name of ARPO: ,�(yiy, .-✓� 7?( -.rr Mailing Address ARPO's email: �AV/f phone* one year from ARPO's 3tensWrW oEh L% a3qis) Revised August 2022 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONf WAIVER FORM CERTIFIED MAIL - RETURN RErvioT ocQUESTED or Ann QUIVERY Crap Portion to be complletteld by owner or their agent) Name of Property Owner. :�51y�a l J/I�9dt �l'6Lr Address of Property: 110 m C-1—C] l Q-ic) M Malting Address of t Owner. �) l�'� YYYI llCx'r'� � r' I`V :) 79 Owner's email:(.I,Yr:CimP_Y"ovnmei'a Phonag: 1ST 26 -7W 1 . Agem's Name: C(Y" dui ' Agenfs Email: hLd-rocxrvzo ijoi-y� e-r,, ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (�ettom oorgon to b@ comoietad by the Adiacent Property Owne I hereby certify that I own prop" adjacent tothe 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 lee r. f, -Ek ` l 1,00 NOT have objections to this proposal. _ I DO have objections to this proposal. Management (DCM in writing within 10 days of receipt of this nodca. Correspondence Should be mailed to 401 S. Gdfgn St, Ste. 300, Elisabeth City, NC, 27909. DCM representatives can also be contacted at (264 264S00f. No response is considered the same as no objection tf you have been notif7ed by Certified Melt WAIVER SECTION (Choose oiily one 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 so cess unless waived by me (this does not apply to bulkheads or dorm revetments). (if you wish to waive the setback, you must sleet the appropriate blank below.) I DO wish to waive sometatl of the 16 setback Signature of Adjacent Riparian Property Owner -OR- 1 DO NOT wish to waive the 15' setback requirement (Initial the blank) Uk Signature of Adjacent Riparian Propertir Owner. 1TFAIMM"..i� TyleadlPrinted name of A"O.-T—Prm-are. �► Malling Address of ARPO-]-Ab�� ARP99 Dom; 'waiver is valid for up to one yearfrom ARPO's Signature" IUk 1(36 -T-OLET �WE Revised August 2022 2.J I-31 F. �r ��r �- �� , ,� �' � ��'� �� ,.. ��,,,v�, . , � � i�a I��Y�� yl � �r_� —;