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Home My WebLink About57045_ZAWASKY, PETE_20110103❑ CAMA / ❑ DREDGE & FILL ` GENERAL PERMIT Previous p ermit # ❑New ❑Modification El Complete Reissue El Partial Reissue ' `'1 Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC El Rules attached. Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) P City State ZIP Phone # O Fax # Authorized Agent ❑ CW k�FW 3.e.TA Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ PWS: ❑ FC: ORW: yes / no PNA yes / no ❑ ES ❑ PTS ❑ UBA ❑ N/A Crit.Hab. yes / no Subdivision City i) :C, t c c , ZIP ';"6e Phone # ( -- j��----. River Basiny.C� Adj. Wtr. Body , s (nat /man /unkn) Closest Maj. Wtr. Body �X7iJ ENHOMMEM � oil ■■■■■■■■®■w.w"IN■ ■M■M■MN■■■■ M■M■N■■MMM■MM■■■■ ■EN■MON■■ ■MM%r�.iM3IMl�■■■■�■■�■■mow■■■■■■■ ■■■■■■■•l■■■!°L'■■■�!■■ems■■■■■■ �:�■■■!■■■■■■■ MENNIM■:■ :■■ ■M■NONMO MEW '{�■:■■■:R_■■■■■ ■■■■■■■■■�I■ML'■■■MOM■■MC■NI�■■■■■■■■■■■■ ■■■■■■■�i1i[i■■■■01■l■■■■■■®■!�■■■■■■■■■■■■ ■■O!!fi�i■■■■■■■�■■■■■ ■■■■■■■■■■MOON NONE M■M■■■M■■■■MOMMO■■MN■NiMNM■M■MMM■NN■ON■ Agent or Applicant Printed Name ! e Signature ** Please read compliance statement on back of permit Application Fee(s) Check # Permit Officer's Signature Issuing Date Expiration Date t Local Planning Jurisdiction Rover File Name 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 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 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 Quality. Contact the Division of Water Quality 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 Raleigh Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax:919-733-1495 Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ I-888-4RCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Elizabeth City District 1367 U.S. 17 South Elizabeth City, NC 27909 252-264-3901 Fax:252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax:910-395-3964 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) Revised 08/09/06 NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Pete Zawasky Date: January 3, 2011 General Permit #: 57045C Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount OW Dredge ❑ Fill ❑ Both ❑ Other ® 169 169 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised:02/03/10 AT. NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary Date '1/ 1 h U Applicant Name l CA e- Zc,, w c\5 K V Mailing Address 361 A `I S J` (�, ()�r\c Ac,\. rjC, )'�571 I certify that I have authorized (agent) IBx (AV-',VNC to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)G�� at (location) This certifi Signature 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www. nccoastal management. not An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper 2010-12-13 16:25 EDITSERVEPLU5 2522492030 » 252 249 2429 P 2/2 CEIMFIED MAIL • RETURN RECEIPT RE ESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM Name of Individual applying for Permit: Peke- Z^wo\S ky Address of Property: 3 6 I M ,S U A, (�(. � � S 71 (Lot or Street a, Streak or Road. City b County) I hereby codify that I own property adjaoent to the above referenced property. The Individual applying for this permit has described to me as shown on the attached drawing the development they are proposkV. A description or drawing, with dimensions, should be provided with this letter. 1� I have no objections to this proposal. If you have objections to what is being proposed, Please wefts the Dhdalon of Cowls/ Manayarrreni; 4W Commerce Avenue, M mhwd Cfty, NC, 29W or csM (M2) NO-2806 w0in 10 days of receipt of this notice. No rogxw se Is conslderrd the some as no objection !/you have been noditd by CertiNed Mall. WAIVER SECTION understand that a pier, dock, mooring pkings, breakwater, boathouse, boatlt(t or sandbags must be set back a minrnum distance of IV from my area of riparian avows 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 requirerment. (Applicant Information) PO &)( 110 Malling Addism Or;t�A..,\, N(. jJ57l City)1tah; z1P (Riparhm Property Owner Information) X z Signahrre Se ok, !'P-e Pr1nt or Type Name aS�-- XIA0\- 14�16\ X yIs Ezy 3��I Telephone Number Telephone Number ojl/ to iL /Z .7 12 DOE � Date �7 • Sd�,� 5 .�. ,,�, � C,,,.ts,x a Page 1 of 1 Site: 361 MILLS RD Y`,%Ud l -'14.5 f{ { 8 US MATS Q. 4 0e.t A r'01 2.00A 7790 90D4 rsa� 7 K081-14410 rr�Q� a e 1.68A �� t r aaa 61-SA" Ave. f 7544 PA. i°+oa3�J K081-145 2.87A 2.24A 5471 °tea 0460 K081-61 K081-69-13 Property Details: START 7927 UNIQUEID 7779 ACCTNUM 1120394 LASTNAME ZAWASKY. PAUL PETER FIRSTNAME CAREOF ET UX ROBERTA A ADDR1 11361 MILLS RD IFADDR2 CITY ORIENTAL STATE NC ZIP 28571 PARRECNUM 4072 NAME ZAWASKY, PAUL PETER MAPNO K081-145 CONTROLNUM CLSCODE INSERT K081 BLOCK 145 SITEADDR 361 MILLS RD SITUSROAD MILLS RD PIN DISTTOWN D02 DBLCIR PARCELNO SITUSADDR 361 EXEMPT LEGDESCI 11 N/S SR 1317 MILLS RD LEGDESC2 GIDEONS CREEK TOTACRES 1.68 CRNTTOTUSE 0 CRNTTOTDEF 0 CRNTLANDVA 114200 CRNTBLDGVA 244133 CRNTOBLDGV 9933 TOTCRNTVAL 368266 JIFIRECODE S IIHOUSECODE I ISEWERCODE I SALEAMNT 29000 SALEDATE 1313011999 SALEDATE2 1172,410 SALECODE 11S ROADNUM 111317 11 PCTCOMP 100 WILLBOOK 11011WILLPAGE 0 DB PG 342/203 DEEDBOOK 342 DEEDPAGE 203 PLAT PCA46-10 `I MOBHOME I10 http://www2.undersys.com/scripts/testadv/usiwebpc.dll/usi?formis=ptmap&MouseX=289... 12/l /2010 UNITED STAB ES POSTAL SERVICE ,�•. . � S a�i„ ".k.';: 'x '• y.:---,� ;_ :. .„.,�„ Hwy • Sender: Please print your name, address, and ZIPT4" tilis box • � �X COMPLETE• ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailplece, or on the front if space permits. Article Addressed/to: Ave, &11l1-� �,At , V A. 1 ,�%oa3 IERY A. Si n_.� i -- ❑ Addressee B. Received by ( Printed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7006 01,00 0004 9789 7345 (1-ransfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 1167 3b 66-30/531 472 Date Pay to the C ,v + 1 I$ 1 U 0 a 0 o Order of F Dollars First Citizens -� Bank j� firstcitizens.com —�( �' LAP For Z�wr:S�C N�.fw, V!'✓ I//.�'"''��.. iur i:053L00300':0047L202L25411' OLL67 IBX PO BOX 190 ORIENTAL, NC 28571