86286A_Johnson, Daniel & Jennifer_20220318

atOc "ru CAMA ❑ DREDGE & FILL �� M 96286 B C D
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Previous permit
E N E RAL PERMIT Date previous permit issued
N New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the Sta/te f North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC `�i a U� ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc jgMLQ414Arules
Applicant Name -D C"', r o �'_ iJ Q/r/t S `' ` .— `Ta 0/� _ Authorized Agent
Address/, — , ifdJ-1 (O 3 Project Location (County):
City �4-M- S State C. zip 27 9 "t Street
Address/State Road/L/ot #(s) S({ z3 7
Phone#(L5L) 3o5—G-7 ✓`/�/ 9D /41Ce�/t�/�Q�t'i ✓2�
Email c� A mi J c-o /Y1 Subdivision
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City �g% rt fDt�ss _ / zip Z77-Y 3_
Affected ❑ CW u IEW v TA ❑ ES ❑ PTS Adj. Wtr. Body t".1 (at/ an/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. WtcBody Glut/; W
ORW: yes/ io PNA: ye no
hype of Project/ Activity
/Z a s%t't 9 .2- a
Shoreline Lewth T �3
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
-,.V1 a✓ "- l' X 5 r $ e_G4-! O ti b e_X r ST7 ,
s' �nsf-� ll /2 Qdd;�ta�� /R6-Ch.r,n) 001
Finger pier(s)
=
Total Platform area
-
Groinlength/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
-
Cubic yards
('
Boat ramp
Boathouse/ Boatlift
_
/
Beach Bulldozing
w
Other 1 2- Ab o
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Cr�
SAV observed:
yes
Moratorium:
yes
no
Site Photos:
rtQ�
Riparian Waiver Attached:
yes
nUo
�J
A building permit/zoning permit may be required by: ]�
Permit Conditions
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❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND AREEVIEWED COMPLIANCE STATEMENT. (Please Initial){—.
1�+ �l n �. �-----
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Agent or ApplicaniPRINTE ame Permit Officer's PRINTED Name
Sign ture "Please r d compliance statement on back of permit'" Sig ure
r 6 1::) __­______.____ ____ V 7 (1-1 3 ZF /-z� 2 h4Z,-Z--'7_
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

PAMLICO SOUND
PIER
PROPOSED
MOORING PILE
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PILE (typ)
EXSITING BOARDWALK
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' DANIEL C. JOHNSON
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DANIEL C. JOHNSON
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57019 KOHLER DR.
57021 KOHLER DR.
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REVISED 03/09/22

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM FRE C I V g
CERTIFIED MAIL - RETURN RECEIPT REQUESTE4J or HAND DELIVERY L
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property: 5
Mailing Address of Owner: e dv / f{� r nrS ; ice% 7 Z 9 -f3
Owner's email: Owner's Phone#: ZT1- .30' -40 9 2 7
Agent's Name: 6 c[-4' es, Agent Phone#: 3y t - & -3 �
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner}
MAR 15 2022
y certify that i own property adjacent to the above referenced property, The individual a yang forthis
has described to me, as shown on the attached drawing, the development the re proposing. A
have objections to this proposal- 100 have o_4Ktions to this proposal.
If you have objectlo to what is being proposed, you rrms tlfy the N.C. Division of Coastal
Management (DCM) In w g within 40 days of receipt of s notice. Correspondence should be
malted to 401 S. Griffin St., 300, Elizabeth City, N 7909. DCM representatives can also be
contacted at [phone]. No sponse is consid d the same as no objection if you have been
notified by Certified Mail.
IVER SECTION
I understand that any proposed pier, d mo ng pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set bad* a minimum tance of 15 m my area of riparian access unless waived by me
(this does not apply to bulkhe or riprap revetmen .(If you wish to waive the setback, you must clan
the appropriate blank belo
I DO wish to waive.,a'f'ime/all of the 15' setback
-OR-
Signature of Adjacent
not wish to waive the 15' setback requirement (initial the blank)
V/ Signature of Adjacent Riparian Property Owneh:'
v1" Typed/Printed name of ARPO:
eriy Owner
✓ Mailing Address ofARPO: 7LIY Cr`Yr �, 1'�l ' ��t� 1PTI k'PilIcJr, cr.
/'ARPO's email: Ve. rrDe-0 � & 1(0-tV& �, enok VARPO's Phoned: a`q '•.� L�
Date: ,"i 0I91W. 'waiver Is vend for up to one year from ARPO's Signature*
11
Revised May 2021

R EC &
N.C. DIVISIC. , OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM MAR 1 5 2022
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) � m " ° 'R p
Name of Property Owner. 124 file / CTo�ir�5�?1
Address of Property: S-90� X, h ie, pr. r " ' ` �rtr.55 AJ C, 2,7 9- 4�
Mailing Address of Owner. D Y 3 �. % � il/e: 2. 7 `%1P3
Owner's email: Owner's Phone#: (0 Z
Agent's Name. !th"� t' rt �' e Agent Phone#:? ;: 2Y 30 ,�
Agent's Email: hRifcYSs�trFycs�i'• Lt'•h1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
y certify that I own property adjace ! --)the above referenced property. The individual ying for this
has described to me, as shown c ie attached drawing, the development the re proposing. A
have objections to this proposal. I DO have otions to this proposal,
ff you have obfectio to what is being proposed, you mus otify the N.C. Division of Coastal
Management (DCM) ; w g within 10 days of recelpt of s notice. Correspondence should be
mailed to 401 S. Griffin St., . 300, Elizabeth City, N 7909. DCM representatives can also be
contacted at [phone]. No sponse is consid d the some as no objection if you have been
notified by Certified Mail.
IVER SECTION
I understand that any proposed pier, d mo g pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum tance of 15 om my area of riparian access unless waived by me
(this does not apply to bulkhea or riprap revetmen (tf you wish to waive the setback, you m sign
the appropriate blank belo
I DO wish to waiveeome/all of the 15' setback
Signature of Adjacent Ri rian Property Owner
-OR-
I o not wish to waive the 15' setback requirement (initial the blank)
t/ Signature of Adjacent Riparian Property Owner. Ct a A C11A:4
Typed/Printed name of ARPO:
✓ Mailing Address of ARPO: (_D® Mom_2
ARPs emai �ARPe's Phone# �--
Date: �, f_ a Z J, � *waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021

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