44277_MELINZAK, DAVID_20060215

a 170G
-!CAMA / D DREDGE & FILL
GE *,*JgRAL PERMIT reP "vious permit #
-New LlModification !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 NCAC
f f Rules attached.
Applicant Name
Address
City_ �Z «'� State YQ ZIP- �� f
Phone # (_ ) YJ �� `/ (' Fax # (` )
Authorized Agent
Affected ' CW DEW D PTA ❑ ES C PTS
AEC(s): C OEA ❑ HHF ❑ IH ❑ UBA J N/A
1 PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County________ _
Street Address/ State Road/ Lot #(s)
Subdivision
City - ZIP - -
Phone # ( ) _ River Basin
Adj. Wtr. Body _ gnat /man_ unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
— - j
Beach Bulldozing_ My
Other-
t
1�
Shoreline Length
SAM 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:
Notes/ Special Conditions
Agent or Applidantprinted'Name
Signature Please read compliance statement on back of permite
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check# Local PlanningJurisdiction 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 [)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 U Other:
D 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 Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
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/ 1-888ARCOAST
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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. (FOR A PAMMOORM P,En1iGdSBOATLIFTBOAMOUSM
I hey certify that I own property 4aceni to fa-��; r `� t'l l s z u _ 's
(Nam of Property Owner)
propez y bmied at 91 C t C)
(I,oi, Block, Road, else-)
Qxt c- c ti V-c. C- C %2c- c--; Il , in .�"' al c , 1 c , N.C.
Mate'body) . (Torun andfak Cvoa%y) -
He has de=nl)ed to me, as sbmm below, the he is proposing at that
kcdiOn, and, I have no ablecdoos to his p mposaL I umkotand that a p lmoarmg
dmoaftmmostbeset backamminnmd stmccoffftemfeet (Mf mmyam
of *10rian access m hm waived by me.
140 nut wish to waive ffie seback ' mint
�C I &A wish to waive that Setback �lir�•n�•±r_
DESCRUYMN AND/OR DRAWING OF PROPOSED DEVELOPAIIIVT.,
. (To bejMed in by individual Pyvpo d"ekpmazt)
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Print or lWe Name
Telephone Number

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1%r l i iVrAi[1ALr JrKVrVAU Y Vie rtM, LATlMUM
(FOR A PDOMOORM 1 ff"GSBOATLIFTBOAMOUSE)
I heresy cuffy that I awn property 4aca t to t:��; �`� -nai x ► -1 z u Y„ is
(Name of Property Owner)
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as _ Cry: k � � C j'leC- ll . , in � �, E_�� C ;,; t , N.C.
Materbodp) . (Town auftir CounLY)
He has desc,led to me, as shown below, the devplopmsent he is proposing at that
hscation, =4 I have no'd*cdm ID his p mp mL I mdecdand that a g
mtrstbe setbackammMmum x offififed (l" fim myarea
of access waived by me.
I tl- o got wish M Naive the sefimck ttim
I &o wish in waive that setback reorement
DESCRIP MN AMDIOR DRAPING OF PROPOSED DEDEI.oMMW.,
(To he Ad is by & ivi&dpmpodng devekparg)
SipaMre- J
C�1c,Ja�
Phut ar Thm Name _
(; " - � 4 1 -
Telephm Number
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INNERBANKS MARINE CONSTRUC N�
P*O. BOX 190 PH. 252-249-1429 RUCTION, INC.'
ORIENTAL, NC 28571
PAY
TO THE
ORDER
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BANK ol',,'2-C` �-'B-k T,.,Co,�.,y
'l-'N'C 285781'
FOR
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