54659_SLYCONISH, JOHN_20091102

1-1 CAMA / ❑ DREDGE & FILL '�'
GENERAL PERMIT Previous P ermit # 559
❑New RJModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural R sources-- I
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached
Applicant Name
Address 1 7 e ii
City "� i, ` I` Stated ' ZIP
Phone # ( , WJ— r r.! ` Fax # ( fy
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no, PNA yes / no Crit.Hab. yes / no
Project Location: County_l
Street Address/ State Road/ Lot
Subdivision
City ZIP-
_�-,: i
Phone # ( ) River Basin W,ir
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Adj. Wtr. Body �' C j, i (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of perfnit t
Application Fee(s) Check #
Permit fficer Si re
Issui Date r Expiration Date
r
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:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

y0�
CDE R
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 lo' 2 �? ' o 5
Name of Property Owner Applying for Permit:
I'j h
Mailing Address:
3.
It
T f e --'-- (t �-8 S 1 2—
I certify that I have authorized (agent) M V eq Z to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
) 0 - 21
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE, RMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent. to
(Name of Property Owner)
property located at t� C ov �T- PN ea c t .�r10 /' e _,C Z 85) z
(Lot, Block, Road, etc.)
on 4>9 iq L in , Is -- N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 57 o -Vo) - 3 o `� g Mailing Address: _ 10 S R6 W a 1,� � C T
el CL oL&: N c 28S 1 �'
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 (l S') 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 kv individual proposing development)
,� �: P 1 e � � ,i7., � .�� i�-� ,� 1 I �➢, e..c-c,; l Y 2 w � Q ,-� .� � -lr � 1� t� � c.-_<..,
L12 5 str --Ac
572-•
(Information for Property Owner Applying Iftarian Property Owner Information)
for Permit)
Mailing Address Signature
City/State/Zip
Telephone Number
gnature Date
,J 0 l-l-tl ,r d Q h'1:'L--i
10 -- Z-Z — v
Print or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Z-0 � ^J S L �c p yy ► (� 's
(Name of Property Owner)
property located at ) 0 3 9Ed W o a � C pv /'T , e,v e k,�a c,C SA o /,-e , /U, C 2 8S) Z
(Lot, Block, Road, etc.)
on CfA v, - +3 Z-- , in T S , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:.S7o -YaI -3o `/ $ Mailing Address: I ° 3 26 w�^o � C T
\ I ANC K&,U HA/LY /JC.. 28S1Z-
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)
��-� ®I � c � ✓>'► a �'"% w ,�- ! 1 �A, e,�-z,;1 Y 2 .ti f= � � � o -lr � 1 cr �✓ A L-c...
y2
5-Z.'
(Information for Property Owner Applying Ri arian
for Permit)
l 4 3 R &7 tuoa
nMailing Address f
City/State/Zip
S7c) —Y� )— 3 ° V 8
Telephone Nu er
agnature Date
Information)
Ivy
Signature
Print or Type Name
elephbne Number
Date

JOHN SLYCONISH
YONG SLYCONISH
2525 KRISTEN LANE
GILBERTSVtLLE, PA 19525
1428
60-7179/2313
BRANCH 703 KC
Pay to the 11 o
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1:2313?17991: 01000467611I' 28