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Home My WebLink About49873_CHLEBOROWICZ, ARTHUR_20070914igti �.S ❑ CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit # ❑New , DModification ❑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 Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City State ZIP Phone # ( ) Fax # ( ) Subdivision ❑ Rules Authorized Agent City__ ZIP__ Affected ElCW ❑ EW ❑ PTA El ES ElPTS Phone # (_) _ River Basin - AEC(s): ❑ OEA ❑ HHF ElIH ElUBA El N/A Adj. Wtr. Body [IPWS: ❑ FC: ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body - Type of Project/ Activity Pier (dock) length Platform(s) __ Finger pier(s)_ Groin length number Bulkhead/ Ripraplength avg distance offshore_ max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift - i Beach Bulldozing j - Other y i Shoreline Length SAW not sure es no — - - ---- --- --- - 499`. 3 ti (nat /man /unkn) (Scale: ) I Sandbags: not sure yes no Moratorium: n/a yes no i _ Photos: yes no�- Waiver Attached: yes no A building permit may be required by: See note on back regarding River Basin rules. Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of per Application Fee(s) Check # PermitOfficer's Signature Issuing Date Expiration Date iq 4 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, certifythatthis project is consistentwith 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:919-733-1495 Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST Fax: 252-247-3330 (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: 252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax:910-395-3964 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) Revised 08/09/06 ADJACENT RIPARIAN PROPERTY OWNER STATEMEN (FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to A Ch/11 (Name of Property Owner) property located at ° '�y , (Lot, Block, Road, etc.) on f l AtO h 0// W-V16 WAY , in f /NE MIDI/ , '#0-00 (Waterbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that loca have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / must be set back a minimum distance of fifteen feet (I Y) from my area of riparian acc waived by me. (If you wish to waive the setback, you must initial the appropriate below.)i o I do not wish to waive P1 a1i�L I do wish to waive that setback requirement. ------------------------------------------------------------------------------------- DESCRIPTION AIND/OR DRAWING OF PROPOSED DEVELOV& (To be filled in by individual proposing development) '�+1 S, 1�i1 �T - S_--- � � g A. 04 c Pis," ivy r v � Sri sT�irr �3 ELK /�/�,s-o. c y,o,c 195f a r. 's 9N�7-600 N.C. , and, I thouse unless SEP l 3 2007 ead City 0CM -- ---- ------------------------- Signature G,��6-�•-� �r' `cam Print or lype Name IL Telepho e Number Date: / — v 7 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGS/BOA TLIF- TI BOA THjO USE) I hereby certify that I own property adjacent to 277-tIL s !�h/eborc��cZ's (Name of Property Owner) ",�'� 1017) property located at LoT -Za 9/-Ock !�, CJrPii'I�SS G{ 4 (Lot, Block, Road, etc.) on PlNE kiN// Ws3it: WA y in f INF eiyoll Sil0e—X-5 ,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 / 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: 1 3 200? (To be filled in by individual proposing development) /W 0re tAl.+rt<2 WA Y - � h,�a� city D _777— A. t0goPosirl> N/Cw /3 uLK i6,4-0 o .v .c / { .� V7-, IP �I a r1 ------------------------------------------- -y/a/e!z Ss-----------------------------�� _ I Signature row/�- Z Print or Type Name Telephone Number Date: D ATM107 e ARTHUR G. CHLEBOROWICZ 06-01 237 THAIS M. CHLEBOROWICZ 107 CYPRESS CT. PINE KNOLL SHORES, NC 28512-6705 �i1 , / 66-19/.30 NC Date — 1 Y—e) � 201 Pay -- to the order of Q Dollars Bank of America ACH R/r 053000196 Memo -140IU--- ':053000 1961: 00068456689 211' 2937�