77758D - Johnson

411 CAMA / DREDGE & FILL N° 77758 A B C
G-,2
GENERAL PERMIT Previous permit# r
)G - New Modification Complete Reissue Partial Reissue Date previous permit issued ,
As authorized by the State of North Carolina, Department of Environmental Quality M' `
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC V 7 \ \2.-(. .
l ` O Rules attached.
Applicant Name )&5on ; AP-'�C a-1 Jv `^�4o., Project Location: County /-.)/tJ�, C k
Address l Vi2 (LoCk, (..,,c�n (,•• Street Address//-State Ro�/Lot#(s) (\ Le
City f !1�lt e"s iD0 � State •-•JL ZIP 'Z-1,-1to �C��1 `lS(^ ,.fir , v-e—
Phone # O-1(1) 3- 1.tI�i3I E-Mail ti4\1 3C-w,ut..S Qctot,c,,,,. Subdivision &-c•
Authorized Agent \ , .,� C4� l'` N.� (A)1 City 4-�0L' „ -C-\.f ZIP Z `'(472
Affected ❑ I CW w PTA DES ❑PTS Phone # ( ) River Basin l..)^ !^'n-,-
❑OEA ❑HHF ❑IH ❑UBA ❑WA
AEC(s): Adj.Wtr. Body A (nat ma . unkn)
❑ PWS: A1��
Closest Maj.Wtr. Body
ORW: yes /(2) PNA yes no II
Type of Project/Activity rr 5L\\ UCk ,i A C:` _. _ \b L ,
-1;a. ;. k2.\ 6(. r ��i r.2 S� i II S 4 (Scale: N )
Pier(dock)length
Fixed Platform(s) I j f
Floating Platform(s) '� i i I i
i-- ., i J i
Finger pier(s) i ....--
Groin length j j
, I A i' �
number I , blf 1
CV---- I
Bulkhead/Riprap length ercS�,,�a I
,
avg distance offshore { 1•t(y G\,.,.\1 r
max distance offshore I
Basin,channel I i 0 a
,.. .3
cubic yards r . icL {
Boat ramp _
Boathous Boatl' )17. NI./; f7*---- --61_1( *_.__. .
Beach Bulldozing f i ti/( 1 `
1
Other
- — ti G
I
I �
l
Shoreline Length �0 ' `{ ( s .5[ri Q(t,0
SAV: not sure yes no 9. j { _` � c"�-e-C Iun
uc¢r .V � _.1.__ of-Zgc�
Moratorium: n/a yes op —�
Photos: yes
Waiver Attached: /y no (�
A building permit may be required by: --1 Qk�Q v'CC. See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction + yy
Notes/Special Conditions ��r,�\l�1- �,\\ es e� P x:.QA r\ P X l c.T r� �< < -- 4 C� t•�-t.
U2 SITS v,,..Ake. C Sct,,. ; ' c..aka
,k3Py( rl h L Cc r,c\c- \3 v�CAC.
Agent or plicant rimed N e PermitOfF nted Name
�____ ��
Signature *"Please read c e statement on back of permit * Signature
ig 2 00 H G 2 A2 UL\ _ t.n 1 r) Z,v 2 1
Application Fee(s) Check# Issuing Date Expi tion Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(910-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-390 I Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7106/17

N < < < CANAL
0 A e
15ft › Sx16ft _6ft
UP 13x13 lift
0 lb
,
5ftxclft
-'#24.5ft
-
-20.5ft >. ,
-33ft •
Jason Johnson
116 Sailfish Drive
Holden Beach NG

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Jason & Jennrfer Johnson
Name of Property Owner Requesting Permit:
1912 Rock Glen Lane
Mailing Address:
Greensboro, NC 27410
Phone Number: 336-337-4331
advsera,ces@ao,.corr
Email Address:
I certify that I have authonzed CPG, LLC `
Agent •Contractor
to act on my behalf. for the purpose of applying for and obtaining all CAMA pemirts
necessary for the following pr development. install boat lift
Pn
116 Sailfish Drive Holden Beach
at my property located at
Brunswick
in County..
I furthermore certify that I am authorized to grant. and do to 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:
(fir-
Signature
Jason Johnson
Pnnt or Type Name
Property Owner
TIve
Date
This certification is valid through
29 2022

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Jason.Johnson
I hereby certify that I own property adjacent to 's
116 Sailfish Drive L-287 Harbor Acres (Name of Property Owner)
property located at
(Address, Lot, Block Road,etc.)
on a man-made canal in Block,
Beach,Brunswick N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Col awl I have no objection to this proposal.
Gary ReR IJan29.2D211611 ESTI
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndivrdua/proposing development must fill i description below or attach sysite drawing),
See attached drawing for boat lift proposal.
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.
(Property OwnerQT Information) (Adjacent Property Owner Information)
Ja Ln J nson(Jan 29,202114:08 EST) Gary Re 6� (JJ��2 2 18:41'EST)
Signature Jason Johnson Signature* Gary Reece
Print or Type Name 1912 Glen Rock Ln. Print or Type Name 215 Sunny Acres Dr.
Mailing Address Greensboro,NC 27410 Mailing Address Lewisville,NC 27023
City/State/Zip 336-337-4331 City/State/Zip 336-408-223
Telephone Number/email address Telephone Number/email address
Dare 1/29/21 Date*
1/29/2021
(Revised Aug. 2014)
*Valid for one calendar year after signature*

1
An -NT Rtfi Rim ne , tis-R.A.TATtiy,ENT ,
j01 --141_,.
voi-ily.,nal 1 0•Arlit pcOpertV 41-4fdtril tt, ,,,,;41/41.:1,„.1 4271-ct ,
-...............--- ......_,-
° rtY$05;e4ti al 111, 4,0 5443L ;44 . Di,,1,7 (Nsmi ot Property wner).
. ,......
, .
on CAL'N.,1k,A„. (*dates*, Loft Block Road etc) 1 .
— -. _..
----,----- ------ ...._ ,,in 7_1'),C.,t,..DETL...1 ti, -,1h.C.I.,,
(Watelindli) 4 (Cityfrown*Rd/of Countyl
"r4V 41!POiclict 44* ditut 1- rno, c,hp..,„1,,-- %A k,,'
SO* int C)0,TOk.Tmeni lltrIp(IW1, at Pv liclicv:t ,
4.1.o.--4•_., 1 ham no-ckmmpon to ttile proposjet ,
._ . I hay!otart<totx)*to tnis rowel*.
- - ..
DE'SCRiPTION ANCVOR ORAVVING OF PROPOSED DCVELOPMENT
"----. '-- -- - -•• --' . '-__-, I--_ '-.: ..,'.' .'__'.4 _1- L' -,.:',A1,0,4404.004411**04.:****.****4010 Installation of boat lift
, .
40,041y0.:}10_4211
I understtrna that $ oiwer, doo.s..',, reloorino ptitrvs,, boat tamp, tirclekpair., boatteogle,, tm, of ,gion
most * set beck a mtriirmtim ortstanct ol IS` trorri Tny arra4 CA'PP4riart MCICZNP ii_trittll Wnetrd Vey
trie, (it you wisb to waive itlIl SCAbil4, Y-04I roust Inlilsi tt* smarnotk rilarat tictori6,,,
.1
•-A ci0 welll to vows tho 15.' *attack n"outtoment ,
do not wooti to swiiiVe104% ti 6 IteibtiO inpcust‘wervelt ,
INOIP4ftY (*OW IngfonnitiOtt) I . • .
i/lott ....,...,
: `,,,,:,,,::*•........;,....e,.,•,-*---****".---"--",-*---
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ChM Ressiv d Date DapwNod Chock From(Nana) Nsmo of Pamft Hordar Vendor 11l Chock
Permit Number/Comments RaesNN or RalundRwlbcaad
Column1 Cahoon! Calumn3 _ _Column4 CWumna CoMnne CoIamo7 Columns Colima'
2/22/2021 3@/2021 MarcSimeone Alice Wilder PNC Bank 211 $ 100.00'minor fee,2110 Washington Acres.Hempstead PnCo 'JD rd.13565
2/22/2021 3/2/2021 Overbeck Marine Const./Daniel Shirley •Chnstopher Scem •SunTrust 5397 $ 200.00 GP#77595D KE rot.13673
2/22/2021, 3/2/2021•Jennifer J Johnson Jason and Jennifer Johnson First National Bank 2623 i$ 200.00 GP#77758D BB rct.12989
2/22/2021 3/2/2021 Anthony Carr Cashiers Check •Nick Sanf State Employees CU _ 101542 $ _ 200.00 GP#778000 BB rct.12968
2/22/2021 32/2021 Backwater Marine of NC LLC •John and Heather Brown BB&T 1246 $ 200.00 GP#77592o BB rct.12970
2/22/2021 3/2/2021 Once Construction of Brunswick County Inc Charles and Shelby Jordan BBBT 14446 $ 200.00 GP#77799D BB rct.12967
2/22/2021 3/2/2021 Rhonda McCall same Bank of America _ 1064 $ 200.00 GP#777950 BB rct.12951
2/22/2021 3/2/2021 CMT3,LLC Carolyn Austin Bank of America 3017 $ 200.00 GP#77780D BB rct.12972
222/2021 31212021,Partriol Boat Lift and Dock Maintenance.LLC Allen and Jan Kelly Aquesta Bank 1031 $ 200.00 GP#80113D JD rot.13566
2)22/2021 _ 32120211CLTMC.Inc. John Lawson FCB 11666 5 20000 GP#77840D Tmac rd.12914
2/22/2021 3/212021 6 6 J Construction of NC.LLC Alma G Davis Trustee/Rhonda Hatch BB&T 2316$_ 200 00 GP#758200 Tmac rd.13530
2/22/2021 3/2/2021 Ann E.Cordell same PNC Bank 1513 $_ 200.00 GP#748890 Tmac rct.12922
2/22/2021 32/2021 Island Contracting.Inc. David Durack __ Branch Banking and Trust __ _ 37555_$_ 200.00 GP#77810D Tmac M.12908
2/22/2021 _3/2I2021 Linda Kanoy same BB&T 10043 Si 200.00'GP#75828D Tmac rct.12921 _
22212021 3212021 Southeastern Coastal Construction Co.(1 of 2) Sean Desmond South State Bank - 12083 $ 200.00 GP#77511 D _ KE rct.12726
2222021• 37212021 Southeastern Coastal Construction Co.(2 of 2) Sean Desmond South State Bank 12100,$ 200.00 GP rf77511 D _KE rot12728
2/22/2021 3/2/2021 Lighthouse Marine Construction Inc. Adam Litton Coastal Bank and Trust 3840 f 600.00 GP#801120 jJD rd.12388 _
222/2021'. 3/2/2021 Davey Resource Group Inc Jared Lipoell United Bank 2192 S 400.00 GP#775970 PA rd.11589