73862A_Hryckiewicz, Michael_20190829

4 CAMA / �_] DREDGE & FILL
GENERAL PERMIT
4New Modification ❑Complete Reissue El Partial Reissue
No.. 73862 L-1�
,:�nV B C D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Ei I ScVy
Rules attached.
Applicant Name H ►c kkt k H ✓ \1 Q w1 C Project Location: County
Address 1 1 3 (c CwL r ,ru ✓ D r
City K% f'cA (7 t ; � we State V P
Phone # (5Ljo) Iipg- 14041 E-Mail
Authorized Agent ke v►.\ ►_'11 , I -
ZIP aauX�;
Affected L1 CW $ EW I PTA )�ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / xCQ ' PNA yes /
t,
Street Address/ State Road/ Lot #(s) A IS P to vt r of
Subdivision Grove. ( << h
City Coyollc, ZIP a19dl
Phone # (
River Basin
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on bac rmit **
ALwo- Go 1aL 4
Application Fee(s) Check #
it Officer's Prin e
Signature
�laFbOle,
Issuing Date Expiration Date

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, 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
Neuse River Basin Buffer Rules
Other:
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 Resources. Contact the Division of Water Resources 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
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(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 - South of New River Inlet -
and Pender Counties)
http://portal. ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 14 1 k, + 7-
Date:
Permit #: 7 30 01 1
Describe belo',�t the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
S
Dredge Fill ❑ Both [IOther ❑
LAC �L
0 S �%
c
Dredge ❑ Fill � Both ❑ Other ❑
d, S c�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to
property located at
(Name of Property Owner)
. L o f - Sec- - bvt, F
(Project Site: Address, Lot, Block, Road`, etc.)
y on �� hS -TS a-K in C i s r r ; -hA ck , N.C.
(Waterbody) (CitylTown and/or County)
Agent's Name #: Mailing Address: Se kn rn; le �f
Agent's phone #: Vi t'l in I V yj
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AN
ESCRIIPTIONANj D/OR DRAWING OF PROPjOSED DEVELOPM(Ey�N-T
P r-e 4p- Ca n a -� 1' e r
acc,ess ;"y dock -
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
(Adjacent Property Owner information)
Signature*
Y/\ ye-41 ewlez Aradlev C. e f svre
Print or Type Name Print or T e Name
Mailing Address Mailing Address
Klng rg�y�.
City/State/Zip
yog 16yl
Telephone Number/Email Address
Date
*Valid for one calendar year after signature*
M
City/Sta to ip
Telephone Number/Email Address
Date* 3/
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
4r,Gk I e,u./ iC 7
I hereby certify that I own property adjacent to Cr1s
(Name of Property Owner)
property located at no
V C-C (+ I,o 1
ii (Pr4,toject Site: Address, Lot, Block, Road etc.)
on 1�Ylt��S TsI4ndin C �i r.1') fctC k ,N.C.
(Waterbody) (City/Town and/orC-7o junty)
Agent's Name #: , C Mailing Address: / 1 S� ii1 /11l e b r.
Agent's phone Y 6 rct l n 1 u- BCa-CL1, VA 23y57
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
c 4-6 Ce.,n+e-r e ti a- L
-�a access m Y J 0Ck
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Grlffln St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail. ,
(Property Owner Information)
Signature
Cli ae-L Hry
Print or Type
//Name
/j�
I J � 1D (&1 r n f� T -(J% .
Mailing Address
L; n el f 'M 22985
City/State/Zi
Llr_/ - -1 u _ IV l
Telephone Number/Email Address
(Adjacent Property Owner Information)
Signature*,—,_
U/ 161 Y1
Print or Type Name
M la n� g Address
Co,- ?) Ila I �C. 2 J U rJ
City/State/Zip
703 -- 6-Q3 - 67A?
Telephone Number/Email ess
,), /,,-7,rc),,
Date Date" I I
+Valid for one calendar year after signature" Revised Jan.2017

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