48401_LUTOSTANSKI, JOHN_20070327

❑CAMA / ❑ DREDGE & FILL '� 48401
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑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 I SA NCA
❑ Rules attached.
Applicant Name ' `,`'�` ' ' ` `> '" c " �.. ' Project Location: County ,••ti .
Address ^.r # Street Address/ State Road/ Lot #(s) S'c•t �,(> ur
City— -- State , ZIP J� ;•
Phone # F ) j Fax # ( )
Authorized Agent
Affected El 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
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
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 r
SAV: not sure yes ,no 7`
Sandbags: not sure yes ` no
Moratorium: n/a yes no
:D
Photos: yes no
Waiver Attached: yes no - --
A building permit may be required by:
Notes/ Special Conditions
TI't 1-4 f)
Agent or Applicant Printed
iN-a-m�e..�J"
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Subdivision,,�-
City ZIP
Phone # ( } River Basin A' Ct,i,Z-q-
Adj. Wtr. Body i ° c*�,- Q( t<- i Cnat'*Vm�)
Closest Maj. Wtr. Body +�
(Scale: ,4 :,C 4.,( )
See note on back regarding River Basin rules.
ct
PefmitOfficer's Signature
3' -.2-7--t)7
Issuing Date Expiration Date
�000 I co C-0
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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888-4RCOAST
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)
Revised 08/09/06

ADJACENT RIPARUN PROPERTY OWNER STATENI.ENT
S
1 herchy cea-tify that i own property adja.ccnt to . IwC +�
property located at
(.Name of Property Owner.)
(,Lot, Block, Road, etc.)
rnt N.C.
(Waterbody) (Town and/oar County)
14.e has described to the as shown below, the developtMnt.'b,c is proposing at that location,
acid, l have no obJections to big proposal.
DESCRIPTION AND/OR DRAWING OF P13,10'POSED DEVELOPMENT
(To be filled in hy.individual prepo-5ing.development)
C'0MS'TR-j4''T /laRaX' 135 1
Or' 'U 1 Nj 2' (');minx oavpea-t j baw6 �t>
.A�o 135�
L v.�141
t> A w it
------------ ---— - - - - - - - - - - - - - - - - - - - - - - -
Signature
A,,
Print or Type Name
Z s 7- - 2- C/9 - aoraoll
Telepb.one, Nuutbcr
Datc- -4? — ` z : _.._—
/eg D 04"64-lC4�u
C)gAAvi?'M� 1 /U G ��S 7/

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1rt% LuT,>, is
(Name of Property Owner)
property located at 5 S? 1 �,z ( >>v«N 7 ham, 1--A2 b
(Lot, Block, Road, etc.)
on 7t1rDRC . �geK- ,in 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
C`t`+N�TR�GT A�C{vx 135 1 / �X15"i'rrty' Pd��
G� '11T1�j, S�AwALL C'Mf \ ��
Si re
Print or Type Name
512f-
Telephone Number
Date: S `(� - C��

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