56391_SAKOWSKI, STANLEY_20100922

❑ CAMA / ❑ DREDGE & FILL
bdG E N I R�►L PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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
Applicant Name_ ProIect Location
^ � w j - / ) ❑Rules attached.
jCoun
Address
City
Phone # (i)_
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
ElPWS:
ORW: yes / no
State ZIP
Fax # (--.-} L--
❑ EW ❑ PTA
[IHHF ElIH
❑ FC:
PNA yes / no
ElES ElPTS
ElUBA ❑ N/A
Crit.Hab. yes / no
tY
Street Address/ State Road/ Lot #(s)
Subdivision
CityZIP
Phone # ( ) River Basin
Adj. Wtr. Body (at /man /unkn) .
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)
Finger pier(s)
-
Groin length
number
Bulkhead/ Riprap length y'
avg distance offshore
i
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
--
I
— ! 4 -_.
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: c ' ' �' 11 ^' ' -' !� / ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
�, c i� 3 11 fi
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
n if
PermitOfficer's Signature j
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 [)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:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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)
Revised 08/09/06

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Stanley Sakowski
Date: September 22, 2010
General Permit #: 56391 C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
HG
Dredge ❑ Fill ❑ Both ® Other ❑
420
84
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ja
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date C, 1 w 10
Applicant Name
Mailing Address
', .ra `-{
�l2
I certify that I have authorized (agent) �1-ht"1 8'.— to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ��Z�
at (location)
This certification is valid thru (date)
Signature
a
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to A 1-,Lc � -59 1-,, J �,
(Name of P operty Owner)
property located at -TC-1
(Lot, Bloc, Road, etc.)
on 4: 4", , in p Y�S , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: i Qs- QPo
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
c :, 4 � `53'-) S
City/State/Zip
Telephone Number
�.14, ,3
Signature Date
(Riparian Property Owner Information)
Print or Type Name
Telephone Number
Date

Z,.40 C'11')1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILIIVGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to • A v-, L ;f 4 k a `� �!'s
(Name of P operty Owner)
property located at
(Lot, Blocll, Road, etc.)
one , in P 1(—S , N.C.
T(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: 13733 �� �� FPO V�
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 (IT) 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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
y z' Re,p.,e4_ti
(Information for Property Owner Applying
for Permit)
11133 u-,m1 79-
Mailing Address
City/State/Zip
Telephone Number
.141 +3
Signature Date
(Riparian Property Owner Information)
Si e ""'
Print or Type Name
Tele hone Nu be
Date

o n
MUD BUCKET DREDGING INC 4575
507 HEDRICK BLVD
MOREHEAD CITY, NC 213557-3045 66-112/531
Date c),zz ; 10
-Pay to the
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