47083_OLKOWKI, JOHN_20060102

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❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification [-]Complete Reissue ❑Partial Reissue
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
Address
City
State ZIP
Phone # O
Fax # O
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
❑ OEA
AEC(s):
ElHHF ❑ IH ❑ UBA ElN/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) ler-h
Platform(s)_
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin, channel
cubic yai
Boat ramp _
Boathouse/ B4
Beach Bulldog
Other
Shoreline Len
SAM ni
Sandbags: n4
Moratorium:
Photos:
Waiver Attacl.
A building permit may be required by:
Notes/ Special Conditions
)us permit #
previous permit issued
L I Kules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
See note on back regarding River Basin rules.
Agent or Applicant Printed Name U Permit Officer's Signature
,;
Signature Please read compliance state me Frh *a v Uing Dace Expiration Date
Application Fee(s)
Check# 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 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
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
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)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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 06/29/OS

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ADJACENT RLPARL- .N PROPERTY OWNER STATFNLE�+T
(FOR A PIER/MOORING PILINGS/BOA7ZIFT/BOATHOUSE)
I hereby cer'afy that I own property adjacent to John � Cu r r,n r OWW3l(i' 's
(Name of Property Owner)
prore,—Ly locates at k) 4 �e r jan P ,
(Lot; Block, Road, etc.)
Souw , in Wf ew dr� lCo-fc"f-f N.C.
on �
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposl-= a, that location,
and, I have no objections to his proposal. I unde.stz:d tt'ia.. a pie./moor nQ
piiings; boadift/boathouse must be se: back a minimum distance of fiineen fee: (l5') from my area
of rpa-lan access unless waived by me.
K_ I dodo nnt wish to .va vE the setback requirement.
C
I �r wish to waive t;.at setback recuirement.
DESCRIPTION Ati-D/OR DRAWLNG OF PROPOSED DEVELOP`IE�7:
(To be filled in by indiv&ual proposing deve!opmenr) 4
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Print or Type Name
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�JACENT RIPA_RL-, PROPERTY OWNIR STATEtiLE,"-T
(FOR A PIER/MOORING PILINGS/BOATLIFT/)3OATNOUSE)
I hereby cer-:iry that I own property adjacent to TA� °� �'� "'"r 6
s
(Name of Property Owner)
prope. �y loeattd at 10 `� 10 a f cr -e A/< e. �" NC
(Lot. Block, Road, etc.)
on Socc n / in l W or /VC C✓.c✓e�t Go�`'�%- .
U aterbody) (Town and o/ r C o u Wtv)
He has desc-Libed to me, as shown below, the development he is proposi-_ a: (,hat location,
and, I have no objections to his proposal. I unde-3t�,d tha_ a pie 'moor n=
p� ir.cc �a fij�0ath0uSe must be se: back a minimum distance o:1 (' -') Fm m ?
o y anti
of r -per:I n access unless waived by me.
I nn wish to wage the setback recuirement.
dLa
I do wish to waive t; at setback, recuirement.
---- ----------- —--- ------------- - -------------
ESCRIPTION A'N-D/OR DRAWLN'G OF PROPOSED DEVELOP [E\7;
(To be filled in by individual proposing development)
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-- 1477
JOHN OR CATHERINE OLKOWSKI
PH. [phone] / 68-7497/2560
104 Water Ln ��20 d
Newport, NC 28570
TO r{/ l —1 $ � 00, D 0
ORDER O DOLLARS 8 �'•�°'•
Navy Federal Credit Union ,I
PO Box3100
Merrifield; VA 22119-3100
FORM -- ---
1:256074974�: L4770 �U'rue� ru r- 1#� J