25669_SOBKOWSKI, JAMES_20000621

CAMA and DREDGE AND FILL
G E N E R A L
PERMIT
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of envir mental concern pursuant to 15 NCAC
Applicant Name Phone Number
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
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, imprisonment 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 of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they
have no objections to the proposed work.
In issuing this permit the State of North Carolina certifies that this project
is consistent with the North Carolina Coastal Management Program.
zip
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

-� 4-1

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
� DIVISION OF COASTAL MANAGEMENT
A4,
ar�
NCDENR
JAMES B. HUNT JR.
GOVERNOR
BILL HOLMAN
SECRETARY
DONNA D. MOFFITT
DIRECTOR
MOREHEAD CITY OFFICE
HESTRON PLAZA II, 1SI-8 HIGHWAY 24, MOREHEAD CITY NC 28557
•
PHONE: [phone] FAX: [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST -CONSUMER PAPER
DENR TOLL FREE HOTLINE: [phone]

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent toC-• • `p�.�
(Name of Property Owneig
property located at
(Lot, N,ock, Road, etc.)
on in , N.C.
(Waterbody) (Town and/or Co
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.
I do not wish to waive the setback requirement.
1." I L.4 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Aa t /� �IJ
ig � ure
A6 1-1,vi e
Print or Type Name
-7U (/- 63 � S— IV Q
Telephone Number
Date:

4 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to R RS A- J1-6C P q Co M N1, ksoA'D
(Name of Property wner)
property located at E ti,d
i= Lc- V'TeA
(Lot, Block, Road, etc.)
on C 6 ,E S u ;v (i , in Cc,; Cry i? l � ,� z' , N. C.
(Waterbody) (Town and/or CouAty
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
p din gs/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I d-Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIMEIN T:
(To be filled in by individual proposing development)
IVA
Signature
Print or Type Name
Telephone Number
Date: