86287A_Johnson, Daniel & Jennifer_20220321

NCAMA [ADREDGE & FILL N9 862187 B C D
LPrevious permit
GENERAL PERMIT
.e Date previous permit issued
O�New ❑ 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:
I SA NCAC ! / Z7C;, n> ❑ Rules attached. V-44eneral Permit Rules available at the following link: www.dea.nc.gov/CAMArules
ApplicantName1.%_Ckn� �-� "n•���---�s+4-��'•'i
Address _T �''' ++a__
City JJZ't TIC 5-State /V �"- ZIP
Phone # =) 3 (Q,3 2 3
Email e40. ^ Sib /j? '� y 2{� r•a� 4 {y7 c, nt---
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Authorized Agent Ge-e i r 1 C, -
Project Location (County): °� <-= __ ___
Street Address/State Road/Lot # s
S" , Z-/ K A i e c- 06 / Q
Subdivision 'et
Citynit>
Affected ❑ CW M*W [0-15TA ❑ ES ❑ PTS Adj. Wtr. Body A1 M f S ,.- , S , s, __1 rL (n/ta man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/. PNA: yes to
Type of Project/ Activity �d
.) n•+' ci.r.
Shoreline Length 1 a
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pler(s)
a
Total Platform area
Groin length/It
Bulkhead/ Riprap length
Avg distance offshore —
Breakwater/Sill _
Max distance/ length —
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing e'I
Other
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SAY observed: yes no �..
Moratorium: n/a yes no
`
Site Photos: no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: _ ev
Permit Conditions
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY
Agent or
Signature —Please redd compliance statement on back of permit"
Application Fee(s) Check II/Money Order
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❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
VD REVIEWED COMPLIANCE STATEMENT. (Please Initial) P
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Permit Officer's PRINTED Name
..a_ Lo-tom`,•"'`-L_
Signat
&/
Issuing Date Expiration Date

PAMLICO SOUND
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PROPOSED
MOORING PILE
EXISYtNG
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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. DIVISIC.., OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED-M&L - RETURN RECEIPT REQUESTEP or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner,
Address of Property: z-4 'Z t7 07 &0 #1, -Z, te-r- L7 - C, r, " H
Mailing Address of Owner: iq 'ex.- 1-4* �s� " Aic y iu
Owner's email: Owner's Phone#:
Agent's Name: 6 -�:7
n Agent Phone#:. 3 0 S71
Agents Email_- h Q He,_Cd-5 s41 r 0C e Y-a- ti A` 60A4
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Semom portion t2 be completed by the Ad{scent Proggft Qw-
agr)
ycertify that i own property adjace A' -) the above referenced property. The individual spIllying for this
has described to me, as shown o, �ie attached drawing, the development the y4ml- proposing. A
i D0-N_OT have objections to this proposal. _ I DO have o0elf5tions to this proposal.
N you have obJectk>-NQo what is being proposed, yyou mus otity the N.C. Division of Coastal
W
Management (DCAf) In within 10 days of receipt of notice. Correspondence should be
within
'
Fft IV 440
mailed to 401 S. GrA n St., 30TO, Eftabeth City, N 7-9"09. DCM representatives can also be
po
cons!
'Sal
contacted at [phone]� nse is con the some as no objection ff you have been
notified by Certiffed M47&;�tzo�,
IVER SECTION
I understand that any proposed pier, df m ' g pilings, boat ramp, breakwater, boathouse, Ilk or
rl-
groin must beset back a minimum 6 Lance of 15 m my area of riparian access unless waived by me
bt
(this does not apply to ulk a or riprap revetmen . (If you wish to waive the setback, you M!j1d shM
the appropriate blank bN N
I DO wish to waiva,4melall of the 15'setback N.,
of Adjacent Ri?qrian Property Owner
154M
not wish to waive the 15' setback requirement (initial the blank) -
Signature of Adjacent Riparian Property Ow.:
Typed/Printed name of ARPO: 1v C
Mailing Address of ARPO: 'D;2 'aL,�X
/"ARPO�j'Liema"'
/,2.—*waiver Is valid for up to one year from ARPO's Sl"ature*
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTF ,,Q or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property', Ie
Mailing Address of Owner: PC) &'o � &, 5 Z /.4,. -2-:7 1 ±1
Owner's email:
Owner's Phone#: ?, T*Z, YC'S -(OD 9 1 "?
AgentAgentPhone#:s Name: C-7
Agent's Email: hg n*.SS,4 r
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
�
nby certify that I own property adjacent to the above referenced property. The individualjoying for this 1proposing. A
p, t has described to me, as shown on the attached drawing, the development the
descrhi n or drawin with dimensions, Must hf, nrovided with this letter_
esc n or win w
development the e proposing.
o ra 1h dimensions
with 'm' n
I D OT have objections to this proposal. I DO have a ', tions to this proposal,
1,
ft ecti b
ff you have objec o to what is proposed 0 mus,,riftty he N.C. Division of Coastal
I e
ip 11;� of I
Management (DCM) In w g within 10 days of re 7, notice. Correspondence should be
w
malted to 401 S. Griffin St, 300, Elizabeth City, N 7909. DCU representatives can also be
ed City,
contacfedat(252)264-3901.No spouse isconsi d the same as no objection if you have been
a fi
notified by Certified Mail.
IVER SECTION
I understand that any proposed pier, d90<mo;bKng pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minirrium,04ance of 1 5`kpm my area of riparian access unless waived by me
(this does not apply to bulkhe'aseor riprap revetmen\(If you wish to waive the setback, you 21y§1 sign
the appropriate blank boloyK
I Do wish to waive,4me/all of the 15' setback
-OR-
Signature of Adjacent Rip kriW Property Owner
not wish to waive the 15'setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:`
Typed/Printed name of ARPO: _AA V1
v" Mailing Address of ARPO:
/"'ARPO's email:, r, IC C s,&? V, O'sPhone#:
VARP
-/pate: I Lk4 � —,,waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021

AGENT AUTHORIZATION FORM FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Daniel C. Johnson
Mailing Address:
P.O. Box 637
Hatteras, NC, 27943
Telephone Number:
252.305.6323
I certify that I have authorized Gary Price agent to act on my behalf,
for the purpose of applying and obtaining CAMA Permits necessary for the
proposed development of: INSTALL 12 MOORING PILE5 FOR BOAT SLIP
My property is located at: 57021 Kohler Dr., Hatteras, NC, 27943
1 further certify that I am authorized to grant permission to the Division of Coastal
Management staff, the Local Permit Officer anf their agents to enter upon the
aforementioned lands in connection with evaluating information related to this
permit application.
This certification is valid through 05/31 /22 .
(Property Owner Information)
X
C
ignat ru e
Print or Type Name
E-- "�S- "'�d
Date
See Above a ;' ?
Telephone Number
4-1�4

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