Pawlikowski, George

TICAMA /'4DREDGE & FILL
GENERAL PERMIT Previous permit #
tRNew ElModification ElComplete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -7
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name Project Location: County
/12
Address
Street Address/ State Road/ Lot #(s)
4/,
'City A 16 -
State J ZIP
Phone # o-, Fax #
Subdivision
Authorized Agent
City.
ZIP
El CW
EW
PTA DES El PTS
Phone#
River Basin
Affected
D OEA
0 HHF 0 IH 0 UBA El N/A
—r/
Adj. Wtr. Body1,
manta
(nat,6AEC(s):
El PWS:
ORW:
DFQ
Crit.Hab.
Closest Mal. Wtr. Body-
yes /t, noPNA
yes,4 no yes n
Type of Project/ Activity
iA 1.
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
ayg distance offshore
max distance offshore
Basin, , channell"5(l, )-e-
cubic yards
Boat ramp
Boathouse/ Boatfift
Beach Bulldozing
Other
Shoreline Length
! SAV. not sure
yes no
iSandbags: notsure
yes no
r
Moratorium: n/a
yes, no,
Photos:
yes no
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(Scale:
IUMNIN—Mm
ONES
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SEEMS
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A building permit maybe required by: IJ
Notes/Special Conditions
or,
❑ See note on back regarding River Basin rules.
Agent o(
A��p Applicant Printed Name
PerjTA0ffSignature 1cv1-
77
Pleasreadcomplian re statement on back of pirmit
17nature read
issuing Date'
Upiration Date
Application Fee(s)
Check #
Local Planning jurisdiction
Rover File Name

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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 officerwhen 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
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:
0 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.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
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)
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

J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to t��ORG'E a7— AWL/.eOwskl 's
./z (Name of Property Owner)
property located at /03 II/CIIIORY_ COCJ27- 01AyZ A-'XlOec %SWOeFs 4 a3 & %r,7-
(Address, Lot, Block, Road, etc.)
on 'G'���� /iVTO .6060.E t-50elluD , in Ic'IAI.E A:-A/Oee- t S'VO1-?F.S , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described tome, as shown below, the development proposed at the above
location.
have no objection to this proposal
have objections to this proposal.
DESCRIPTION AND/OR.DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
CrVAlAL Our /t;?.v
0,/�, 51-1 cwAi 43r l9,vct-osEa •DorTe,p
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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�EM VW
do wish to waive the 15' setback requirement.
JUN 0 6 2014
do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owne 1
Sig natur Signatur
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Print or Tye Name Print or Type Name
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Mailing Address /p Mailing Address
l�2.�,zps4/�OE if/C �85 �O�' /r9UL,BE�Y COC)27'
City/State/Zip City/State/Zip
Telephone Number Telephone Number
Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cexie. 1 pt Ko Wk 's
ame of Property .Owner)
property located at -/0.9 H/C&O R Y C'Ol1RT RIME /<.Vacz_ Sf/oRES L a3
(Address, Lot, Block, Road, etc.)
on Co9,1V44 Mlrto aQ6UEJSWuoin 42/NE .,lWDGe +SH��PF-S , N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
411 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Cf7N /q L Our x7'J 'q.2E4
005�5 #_ O04U N '19Y 4isuc_tassE o
C/i4//4L CENTER - - — Drprm Rr4a w rt •�0rr$ayy �/.VE ?`o /4G�OLv
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r p1)E 1-Tw r-3 � eo*-.r _-_ , 4- 40GCS 77.04E kb 4c QE 3"
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WAIVER SECTION`'
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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.)
do wish to waive the 15' setback requirement. RECEWED
do not wish to waive the 15' setback requirement. 201
MiN 0
(Pr perty Owner Information) (Adjacent Property ner formation)
f ) M-Ma crry
_=2X - I
Signature Si a tre
oT �i�i 1%1�L lKO l�t%S.C� / %03 o ' �.�.
Print or Type Name Print or Tyne, Name.
.387 �av v�-.ey -G t U8 .�RivE fcko�- �.
Mailing Address Mail' g Addre/ss
R.eA�igh/O E N Vic./Dil/_ �T iUL1 GG O,�s NC
City/State/Zip City/State/Zip
Telephone Number Telephone Number
/X} .5- .�/- Ile
Date Date
(Revised 611812012)