51544_NAWOYSKI, WALTER_20071203

4/6-1,544
❑CAMA / ❑ DREDGE & FILL L'
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 Reso rces
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address
City - State ZIP
Phone # (`) = Fax # ( )
Authorized Agent
Affected 0 CW ❑ EW ❑ PTA
AEC(s): D OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
N
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City '., . ? � ZIP .
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body —
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale:. )
Groin length
number
Bulkhead/ Riprap length
av8 distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing777
Other
1
i
I
�
Shoreline Length / b
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: 0 See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
r ,r;
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction 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
landowners).
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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
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)
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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director raLM
Date 11 l I `7 NOV 2 9 2007
Morehead wit)
Applicant Name l� (1 i T �� --1 : Nei 1'�nTS kl
Mailing Address lcj�-L t aw -WAii) 4)t.S L iy e or
N ELo -� �N N e ')kSG,�
I certify that I have authorized (agent) 1, iW -k u o l^D to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ` ` FI . t u L i tfyc("K ,
at (location) I G T ` G w�k qlj 7 r s L--' I lm 1,
This
Signature
a is valid thru (date)
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 110% Post Consumer Paper

ADJACENT RIPARIAN PRORERTY O`VNER STATE;\IE';T
(FOR A PIER/b1OORIiVG PIL[iN'GSIBOATLIFTIBO,4THOUSE)
I hereby certify that I own property adjacent to 's
(Name of Propert•O•�ner)
property located at � ///-, + }
(Lot, Block, Road, etc.) M'I f
on ,rf. � , i n
(NVa erbody)
(Town and/or Count),)
He has described to nie, as shown below, the development he is pr sin; atNtg?t tc�t�,�n�
and, I have no objections to his proposal. I understand that a pier/niooring pi tliftlboathbt
must be set back a minimum distance of fifteen feet (i 5') from my area of riparia unless
waived by me. j
I do not wish to waive the setback requirement. ��
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRANVING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing develop cent)
C-----------------------------
e-A
Telephone Number
Date:
I

ADJACENT RIPARIAN PRORERI-1. OWNER STAT£:1IE1
(FOR A PIER�IIOORIIVG PILI,'VGS,BOATLIFTIBOA. H or SEA
I hereby certify that I own� 9 � .�0
property adjacent to L
�sg
(`ame of Propert�� O�•nerg�
property located at / .� Lam, _ _ �_ /, ' /_ a004
(Lot) Block, Road, etc.)
on
(ovate � -•j %..�._..�,, , in .�;�„ �.
o , N.C.
(Town and/or Count)
He has described to me, as shown below, the deve10p71ent he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring piiinss'boatiiR'boathOLi5e
must be set back a minimum distance of fifteen feet (i 5') from my area of riparian access unless
waived me.
Nff rv—
i do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
---------------------------------
ESCRIPTION ANWOR DRA«•I\G OF PROPOSED DEVEL.OP,NIE,NT.
(To he,filled in br indb dual proposing develop1j,
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Signature
Print or Type Name
Te
�ephone Itttmber
Date; rf

LG ARNOLD DOCKS & SEAWALLS
2779 MILL CREEK RD
NEWPORT, NC 28570
PH.252-241-2636
1184
66-1121531
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