34786_SIENKIEWICZ, ROBERT AND GERALDINE_20030929

CAMA DREDGE & FILL
4�
GENERAL PERMIT
Previous p rmit #
LJNew ' -Modification 'Complete Reissue
E Partial Reissue 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
E] Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot
City--- State— ZIP
Phone # ( Fax #
Subdivision
Authorized Agent
City ZIP ---
Affected [] Cw EW El PTA El ES F- PTS
Phone # River Basin —
AEC(s): El OEA i HHF I- IH -- UBA 0 N/A
Adj. Wtr. Body enat /man /unW
El PWS: - I FC:
ORW: yes / no PNA yes / no Crit. Hab.
yes no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s) FT T
Finger pier(s)
—
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore—
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
—
—
—
— —
—
L
T J
Ts
J
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
4LL-
River Basin rules.
on back regarding
See note
Agent or Applicant P intelparril
Signature ** Please read corril?T&
Application Fee(s)
on back of permit"
Check #
Issuing Date Expiration Date
Local PlanningJuriscliction 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:
El 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:[phone]
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

3129
Robert J Sienkieuricz
Genie Szenkiewicz G 1"I66-30/54312
20 Bay Point Rd. Date
Merritt, NC 28556
Pay to the Order o�I
f
�y -U , /U C) Dollars 8
0 HRST CITIZENS13^472
V Fir-4.1. ore Bank 6 Trust Company
A %iemal. N.C. 28577
www.firstcitizens.comNP
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OClnr�e Amnran

ADJACENT RIPARIAN PROPERTY OWNER STAZEMEENT
(FOR A PIERIM00RING PILINGSIBOATLIFIYBOATHOUSE)
•
•
I hereby certify that I own property adjacoent g & Geraldine Sienkiewicz ,S
(Name of Property Owner)
property located at
on Bay River
Lot # 14 20 Bay Point Road / Bay Shore Estates
(Waterbody)
(Lot, Block, Road, etc.)
in Pamlico Co. Merritt , N.C.
(Town and/or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
kPC'T' ',' 1JD7 To SC-ALC
`13tiLK N-�At qa
Signature �—
Print or Type Name
(e/d -'973- 85'&(l
Telephone Number
Date: Z9 0 3

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
11
•
FA
I hereby certify that I own property adj cent tot &Geraldine S i enk i ewi c z ,S
(Name of Property Owner)
property located at
Lot # 14/20 Bay Point Road' / Bay Shore Estates
on Bay River
(Waterbody)
(Lot, Block, Road, etc.) --
,in Pamlico Co. Merritt , N.C.
(Tow-n and/or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fin feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRUMON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�Ropos€ p A o 0 zY zdN T�
LK gi � t 90
•
zI , V 4e '<�' V--" z) i1v -V
Print or Type Name
(7/T ) `-/7q- 06 3
Telephone Number
Date: Y/ � �/� 3