101346C - Johnson

3o1d,couV ❑CAMA ❑ DREDGE & FILL N9101346 A B ;G D
GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification E]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:
15A NCAC ❑Rules attached. General Permit Rules available at the following link:www.dgq.nc.gov/CAMArules
Applicant Name I " il "o ri Authorized Agent ii J �i c
Address S K V ��i ,� I / Project Location(County):
City /vim y L s✓I State Al ZIP /fL Street Address/State Road/Lot#(s) �Yl
Phone# —6.q — a
Email �;41,1 ic'r��kv �� n r, l G ✓1 Subdivision
✓ pp
City 6C^'-t to✓} ZIP oil;
Affected ❑CW ©EW ❑PTA ❑ES ❑PTS Adj.Wtr.Body t N S S i !'G �( (y�it/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body 4 A fI f
ORW:yes/no PNA:yes/no
Type of Project/Acti ity G �o vn, ✓�', cL,S
j,: ,• (Scale:IV
.;
Shoreline Length )�J os
Access Length
Pier(dock)length U
Fixed Platform(s) j h
Floating Platform(s);! .X. G
1
Finger pier(s) � � ( f � (. i L't � o
Total Platform area
Groin length/# _ s
Bulkhead/Riprap length ; r V '✓�+ t 1 'j' J. C� f
i
Avg distance offshore
Breakwater/Sill
),Iv
Max distance/length
Basin,channel
Cubic yards
Boat ramp -
Boathous Boatlift r ,
Beach Bulldozing
Other j F c .6
SAV observed: yes nq
Moratorium: n/a yes (1119
Site Photos: yes 6y
Riparian Waiver Attached: yet/ no
iL
A building permit/zoning permit may be required by:
!„��7 ❑ TAR/PAM/NEi,)SE/BUFFER(circle one)
Permit Conditions c a—+'ce• Iq 6
mach 61' 4 /0�Y G 7i) ❑ See note on back regarding River Basin rules
� ) 6�� J,�, • �r - �`� y �� t; f �.X «��l fly' {,�r►'' Nt�
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
, A 'L Col
Agent or Ap ant PRINTED Name Permit Officer's PRINTED Name
Signature"Ple se read compliance statement on back of permit" Signature
-cam I") IDS II11CI)It CallC1/25
Application Feels) Check#/Money Order Issuing Date Expira6n Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar- Pamlico River Basin Buffer Rules 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

o1*000ARk&FICAMA ❑ DREDGE & FILL N9 101346 A B C D
-ok
Previous permit
GENERAL PERMIT
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 Commission in an area of environmental concern pursuant to:
15A NCAC ❑Rules attached. ❑ General Permit Rules available at the following link:www.deg.nc.gov/CAMArules
Applicant Name Authorized Agent V f
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s) r1 `1
Phone#(_)
Email ✓ Subdivision
City C-1 ,. ZIP
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: )
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin,channel
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other h
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: t'
,�� ❑ TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
ki / L , i,L xi ❑ 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 REVIEWED COMPLIANCE STATEMENT. (Please Initial)
!l m
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signature L/
Application Fee(s) Check#/Money Order Issuing Date Expira'on Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar- Pamlico River Basin Buffer Rules F-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
1 CERTIFIED MAIL RETURN RECEIPT REQUES Qr HAND DELMRY
(Top portion to be completed by owner or their agent)
Naas of Property Owner. � L1' I �p S -:Sib h Y1 S o Kf
Ad�ess of Property: 12F� C� �^ G v S C'(J i V
luMaging Address of Owner. 3 1 �� g i ) i3 ! y d . tJ �, rn
Ow er's email: Owner's Phone#: '25 Z 2 toss 4�
252z4 ) -� �04
Ag�nt's Name��4 n � a-''n�.S Agent Phone* 1
i
Ag is n `Email: i�'1 U[� c,s � n� �g i e L o V'A
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(—Bottom portion IM be completed by the ftaceM Property Owner)
I hereby certify that I own property adjacent to the above referenced pmperty.The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
Jec
goon or drawing.with dlmensions. must beRided with this letter.
I DO NOT have objections to this proposal. 1 DO have objections to this proposal.
If Vw have objections to what Is being proposed, you must notify the N.C. Dlvtsion of Coastal
Makagement(DCM)in wridng wfthin 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted
at(;52)808-2808. No response is considered the same as no objection ff you have been nobbled by
Ce irfflied Mail.
i 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
(thi$does not apply to bulkheads or riprap revetrnents).(if you wish to waive the setback,you musts n
.the appropriate blank below.)
I
1 wish to waive some/all of the 15'setback C l�
C t w-r-
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." n
Ty rimed name of ARPO: r' 1 ja n uO r i e—z a.
Ma g Address of ARPO: O
A s email: kb n a cA r 1 L2p4f�14, ARPO's Phone*:
TTs e o✓►+
Da e:")� _ —*waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021

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