60149_KOWSKI, JOHN_20120618

i1CAMA / DREDGE & FILL >N t NO. 60149
GEIVERAL PERMIT Previous permit #
El New ❑Modification ❑Complete Reissue _I 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 Project Location: County
Address
City
State ZIP
Phone # (_)
Fax #
Authorized Agent
Affected CW
O EW Rj,PTA ❑ ES ❑ PTS
AEC(s): OEA
1 HHF ❑ IH ❑ UBA ❑ N/A
PWS:
r7 FC:
CIRW: yes / no
PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s) _ X1(C.
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
Shoreline Length
SAV: 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
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
i
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # () River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: I ' ... L; )
F� See note on back regarding River Basin rules.
Permit Officer's Signatures`
a
Issuing Date Expiration Date
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, certifythat 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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ I-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)

Aaplicant:
Date:
Describe below the HABITAT disturbances for the application. All Values should match the name, and units of measurement
found in your Habitat code sheet.
DISTURB TYPE
Habitat dame Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tamp impacts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amo t)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tempimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
'1.S2-30J21.220=: ..-Yj34•; i'GU >/ .. P'9)!A!l•'AA

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 21 00t✓ [.2-
Name of Property Owner Applying for Permit:
4 n 04 KD ti/ s li -Z
Mailing Address:
10 `1_ Wa f-ey /,n `
IJatV 7'- � C e S �y
I certify that I have authorized (agent) &&-r- GJc-tt--' Aa,4,,�ye to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Roo � ,
at (my property located at) 1 Q tf A0 4 p-rr / n , N.utia i' 1 %C
This certification is valid thru (date) / J
Property OwngVSignature Date

D1VISlON OF COASTAL MAP,1ACEMENT
,�DJACCENT RIPARIAN PROPERTY OVINPR NOTIFICAT1O`aMRIVER FOPilii
Nar-ie of Individual applying for Permit.-_ J- h h OZ kilo W s*-I
A•,Hrtra;, of �rrrar�:i
0,
e 4L) ,oe r f /U
(Lot or Street #, Street or Road, City & County)
I hereby certify. that I own property adjacent 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 proposing. A description or drawing, with dimensions, should be provided with this letter.
_ . x _ 1 have no objections to this proposal..
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
10 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certitled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags must
be set back a minimum distance of 15' from my area of riparian access 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 requ
(Applicant Information)
Of lD d-__r � h
Mailing Address
A)Cw4e;_t
City/St te/Zip
Telephone Number
/0 17.Z01.),
Date
Owner Information)
vyu tui u-
rint or Type Name
2 Z-Z,2_3
Telephone Number
Date

DIVISION OF COASTAL MA, AGE—MENT
ADJA(3ENT Rlt'A,RIAT1 PROPaRTY OVIINPR TiOTIFICAT10`i YIA.IVER FORiiki
Narne of Individual applying for Parrnit.-�J o�h OL %/10wsk.T
ririra rif Prrrprku l 0 Ne h) 6r f iJ
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent 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 proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposel..
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557orcall [phone] within
90 days of receipt of this notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, boatlift or sandbags must
be set back a minimum distance of 15' from my area of riparian access 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 requirement.
(Applicant Information)
l 01 10 u-hif r Z n
Mailing Address
City/St te/Zip -
2 S 2 2 Lt 7
Telephone Number
0 na6, 2-01-2,
Date
(Riparian Property Owner Information)
Signature
/V �r
Print or Type Name
Telephone Number
Date

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RECEIVED
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WCB BUILDERS LLC
2432 SMOKERISE CT 1324
RALEIGH, NC 27615
66-112/531
DATE
PAY
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APR 9 2012
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