32887_WASICKI, SHIRLEY AND JIM_20021021

❑CAMA / ❑ DREDGE & FILL 1 � '�887C
GENERAL PERMIT Previous permit#
❑New ❑Modification El Complete Reissue ❑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 /
❑ Rules attached.
Applicant Name ;j�,, 1,y : J ��C�S i C ✓< ,
,
Address V t)c-, 11_, _ . i r
City
' ` �, State �; C. ZIP ,--y' `� ,X r ( /
r- t . i + ,
Phone # Of-/ , < Fax # ( )
Authorized Agent
Affected ❑ CW E5W ( PTA ❑ ES ❑ PTS
ElOEA [IHHF ElIH ElUBA El N/A
AEC(s):
❑ PWS: ❑ FC:
ORW: yes / no - PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
1
r
Platform(s)
Finger pier(s)
Af Ir
�5
Groin length
numberP length
Bulkhead/ RiPra len h
I
avg distance offshore
max distance offshore
tI._....-._..
.---
1--
�
Basin, channel
I
Project Location: County r 'r r, yr n
Street Address/ State Road/ Lot #(s)
Subdivision
City , C,: ,) D. ,, , , ZIP i
Phone # O i1 i '"! River Basin_ r s e--
Adj. Wtr. Body ( at man /unkn)
Closest Maj. Wtr. Body
cubic yards
Boat ramp
Boathouse/ Beatlift i c D
Beach Bulldozing
'
Other__
Shoreline Length
�„
SAM not sure yes C:'o-)':
Sandbags: not sure yes
Moratorium: r' n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
(Scale: N ay.e— )
[tl'See note on back regarding River Basin rules.
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Permit Officer' ignature
l -�v er 2cnaI-��h/3
Issuing Date Expiration Date" + _
LYr� Val sty 01" f o V13-4 /4
Local Planning Jurisdiction Rover File Name

0
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:
leuse 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
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

PAY
TO THE
ORDER
DECKS N' DOCKS
CONSTRUCTION, LLC
PH. 252-637-1595
243 FOREST GLEN DR.
POLLOCKSVILLE, NC 28573
ZZ61-1�
0
BB&T
BRANCH BANKING AND TRUST COMPANY
NEW BERN, f{4ORTH CARO I aW- f&)
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FOR T;lAII WS � z- y 67 #&Zeb
s'o �115002L82115 1:0 3L0L1231l:5L956
2182
_ 66-112/531
DATE 01901
2 9 F3
COLLARS B = —

I n rH rc i A iv YKUYN;K 1 Y U WiNhX �'1'A'1'EN1EN'1'
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOA?'HOUSE)
I herebycertify that I own property adjacent to
fY P Pe1h' J
(Name of Property Owner)
property located at
on :-
(Waterbody)
(Lot, Block, Road, etc.)
in N. C.
(Town and/or Cou ty)
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 DEVELOP MNT:
Signature
Print or Type Name
Telephone Number
Date:

rw�r��.�ly t turtittlAl� YKVYLKI Y U W1VK �'1'A'1'Elyli�IV'1'
(FOR A PIER/MOORING PILINGS/BOATZIFT/BOATHOUSE)
I hereby certify that I own property adjacent to _ `,A i'� 14- !.&"' _ _ 's
(Name of Property Owner
property located at n, J,-
(Lot, Block, Road, etc.)
on %jam, _o r !�i��in r-tea, �- e!, /, , N.C.
(Waterbody) (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/boatliftlboathouse 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.
DESCR MON AND/OR DRAWING OF PROPOSED DEVELOPV.f NT:
(To be filled in by individual proposing development)
J-7r-o
Print or Type Name
? � - Y r'� J-
Telephone Number
Date: _/ 0 —� l - ;9 Z.-