75543A_Tarnacki, John R._20200115

1 CAMA / - DREDGE & FILL NO. 75543 "L
-. GENERAL PERMIT Previous permit# CA B C D
1_7P1ew Modification Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality j Z �— -
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / ' /
/ �flales attached.
Applicant Name -I �h /I Tarn a.c� Project Location: County D
- Address L j S G M 5 r.
City J t- ite State ZIP 3 2 5
Phone # y 75 E-Mail
Authorized Agent
Affected ❑ Cw P�RTA ❑ ES ❑ PTS
AEC(s): a OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / lno ',, PNA yes / no
Street Address/ State Road/ Lot #(s) L- o 4- 41
70S /S1 anoke L.3
Subdivision d / Nays 14, J & vc
City L Q R �14 ZIP_;7_7 y S L7
Phone # ( ) River Basin o.S
Adj. Wtr. Body n , nat an unkn
Closest Maj. Wtr. Body " s n � j` - S, t✓
Type of Project/ Activity _1_ + 1 l 2 / ^ 7 �'� 3 X /Y'
(Scale: " : Zo )
Pier (dock) h
Fixe,
Flom
Fing
Groi
Bulk
Basil
Boat
Boat
Beac
Othi
Shor
SAV
Mor
Phot
Wain
ng Platform(s)
r pier(s) _
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_
i length
number
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■■■■■■■■■■■■■■■■■■■■�■■■■�■■■■■■■■■■■■■I
avg distance offshore
max distance offshore
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■■■■■■■■■w■■■■■.ter■■■■■■■■■■■■■■■■■■■■■■
cubic yards
■■■!��■rto■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
ramp
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Bulldozing
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dine Length
not sure yes
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mom
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torium:yes no
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A building permit may be required by: PC ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) IJ
Notes/ Special Conditions H r" c �. I S /h e �`( , •� ,-
U
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Agent o�,*plicant rinted a Per itofficer's Printed Name
Signature Please read compliance statement on back of permit Sig T
`� s3 s% S i YZ�_
Application Fee(s) Check # 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 ❑ 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (9 10-796-72 15) for more information on how to complywith 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/ I-888-4RCOAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: o/ "�'ell
Mailing Address:
Phone Number:
Email Address:
1 certify that I have authorized
'7<-7--2 -/y7S-
Agent I Contractor
J.
to act on my behalf, for the purpose of applying for and obtaining all CAJ MA permits
necessary for the following proposed development: _yCi l ��
-? '�- I p16J4rfv'�'
at my property located at
in ,8y'� County.
1 furthermoi-e certify that i am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
, 'ZAT—' - —
Signature
r
Print or Type Name
Tide
Date
This certification is valid through I 1
Revised Mar_ 2016

<-, V ---> f

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FOR"v9'
Name of Property Owner:
,J o lkr, �acacx-lam
Address of Property:
7c) Se—o a � 0 ke— - / vCt�b 14a O't
(Lot or Street #, Street or Road, City & County) U
�MA-o
Agent'sName#: e1�0& 1 ' had/AAailing Address: �% 6
C
Agent's phone Ma
1 hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
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 1367 US
17 South, Elizabeth City, NC, 27909, DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.
I do notwish to waive the 15' setback requirement.
(Property Owner Information)
Signature /
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Print or Type Name
Mailing Address
In}'377Z�,
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City/StatelZip _
75 -7-7-2 7 �
Telephone Number
fc - .-7, '
Date
(Riparian Property Owner Information)
Signat
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Print or Type Name
Mailing Address
Cn ,�
City/State/Zip
Telephone Number
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Date
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■ Complete items 1, 2, and 3. A. atu
■ Print your name and address on the reverse X ❑Agent
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the mailpiece, B. Rec ived by (Printed Name) C. D to orz
eliverr
or on the front if space permits. i (Z 0
1. Article Addressed to: D. Is delivery address different from item 1? LJ Yes
If YES, enter delivery aat)ress below: ❑ No
3. Service Type
C Priority Mail Express®
O Adult
0 Registered Mail —
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nature Restricted Delivery
❑ Registered Mail Restrict
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ertified Mail®
Delivery
9590 9402 4341 8190 7596 54
Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
_
2. Article Number (Transfer from service label)
0 Collect on Delivery Restricted Delivery
0 Signature ConfirmationT'
-- �d Mail
O Signature Confirmation
7018 2290 0000 9429 2681
d Restricted Delivery
Restricted Delivery
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1;5PS
Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

USPS TRACKING #
• s 4a.;:' First -Class Mail
Postage & FeesjPaid
USPS
Permit No. G-10
9590 940P11i 11 8190 759L 54
United States
Postal Service
• Sender: Please print your name, address, and ZIP+40 in this box*
EMANUELSON & l;AD iNC
P.O. BOX 448.
NAGS HEAD, NC 27959
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12/27/2019
Brenda G. Aston ttee,
320 Middle Street,
Portsmouth, Va 23704
re: John Tarnacki — 4705 S. Roanoke Way, Nags Head
We have been requested by the above property owner to do the following work:
1) Remove old platform and construct new 3x18' platform to access lift.
2) Install 1-10K Boatlift.
In order for us to obtain the Cama permit for this project, Cama requires each adjacent property
owner to be notified. We would ask that you sign the attached form and return to us as soon as you can.
You may fax it to us at 252-261-1115 or scan and email or simply mail. We are also attaching a sketch of
the proposed area. If you have any questions please do not hesitate to contact us. If you do have any
objections to this proposed work, you may contact Cama (Coastal Area Management) at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely,
Jackie Lewis
Emanuelson & Dad Inc

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
II
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#Name of Property Owner: k
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Address of Property: %o �D � G'`— L —` ' r c,
(Lot or Street #, Street or Road, City & County)
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Agent's Name #: t mt�l) P �D� ' � Z Iµ Mailing Address: /J 6 1�-O
Agent's phone #: �--- N c 2 7 S
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
t �
X I have no objections to this proposal. I have objections to this proposal.
c
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 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified by Certifr"ed Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
l do wish to waive the 15' setback requirement.
>< I do not wish to waive the 15'setback requirement.
(Property Owner Information)
Signature /
Print or Type Name
I�,&I's,rts
Mailing Address
b a ex d
City/StatelZip _
-7 ��) -71-7
Telephone Number
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
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Mailing Address
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City/State/Zip
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Telephone Number
Date -
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■ Complete items 1, 2, arrdt.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, ,
or on the front if space permits.
1. Article Addressed to: I---
S��s � tc_
-Z
IIIIIIII III IIII I II IIIII � I I III I I
9590 9402 4341 8190 7596 61
2. Article Number (Transfer from service label)
7019 2280 0000 7925 1438
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A. Signab _
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X
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B. Receive y tinted Nu,,,., j C. Date of Deliver
D. Is deliveryem 1T ❑Yes
If YES,.440d�Nlile
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3. Service Type
❑ prinrlh, � '-il =�nrsss;O
❑ Adult Signature
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❑ Adult Signature Restricted Delivery
8-C'tstifrd Mail®
❑ Certified Mall Restricted Delivery
O Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
C Signature Confirmation*
--d Mail
C Signature Confirmation
d Mail Restricted Delivery
Restricted Delivery
i500)
nnmastic Raturn Ranainl

9590 9402 4341 8190 7596 61
United States
Postal Service
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+40 in this box*-
EMANUEL.'SON & DAID INC
P.O. BOY, 448,
NAGS HEAD, NC 27959
11 h i il il'i 11 lij .))I Il !h! i & Ili ll'tHI, tliIII iiltll'tll't.! III

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❑ Return RWOV (copy)
❑ Rehm Receipt (electronic)
1
Postmark
❑ CeMed MWI Restricted Delivery
❑ Adult Signature Required
$ -T
$ 110-00
Here
❑ Adult Signature Restrided Delivery $ -
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'ertified Mail service provides the following benefits:
A receipt (this portion of the Certified Mail label). - for an electronic return receipt, see a retail
A unique identifier for your mailpiece.
associate for assistance. To receive a duplicate
Electronic verification of delivery or attempted
return receipt for no additional fee, present this
delivery.
USPS&postmarked Certified Mail receipt to the
A record of delivery (including the recipient's
retail associate.
signature) that is retained by the Postal Service"
Restricted delivery service, which provides
for a specified period.
delivery to the addressee specified by name, or
to the addressee's authorized agent.
mportant Reminders:
Adult signature service, which requires the
You may purchase Certified Mail service with
signee to be at least 21 years of age (not
First -Class Mail', First -Class Package Service®,
available at retail).
or Priority Mail® service.
Adult signature restricted delivery service, which
Certified Mail service is notavailable for
requires the signee to be at least 21 years of age
international mail.
and provides delivery to the addressee specified
Insurance coverage is notavailable for purchase
by name, or to the addressee's authorized agent
with Certified Mail service. However, the purchase
(not available at retail).
of Certified Mail service does not change the
insurance coverage automatically included with
certain Priority Mail items.
For an additional fee, and with a proper
endorsement on the mailpiece, you may request
the following services:
- Return receipt service, which provides a record
of delivery (including the recipient's signature).
You can request a hardcopy return receipt or an
electronic version. For a hardcopy return receipt,
complete PS Form 3811, Domestic Return
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■ To ensure that your Certified Mail receipt is
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IMPORTANT: Save this receipt for your records.

-- — --- - - - - -
PO Box 448
6705 S. Croatan Hwy
-'Nags Head, NC 27959
Phone: [phone]
Fax: [phone]
email: emanuelson(a)embargmail.com
12/27/2019
Salty Souls Inc
PO Box 69
Nags Head, NC 27959
re: John Tarnacki — 4705 S. Roanoke Way, Nags Head
We have been requested by the above property owner to do the following work:
1) Remove old platform and construct new 3x18' platform to access lift.
2) Install 1— 10K Boatlift.
In order for us to obtain the Cama permit for this project, Cama requires each adjacent property
owner to be notified. We would ask that you sign the attached form and return to us as soon as you can.
You may fax it to us at 252-261-1115 or scan and email or simply mail. We are also attaching a sketch of
the proposed area. If you have any questions please do not hesitate to contact us. If you do have any
objections to this proposed work, you may contact Cama (Coastal Area Management) at 252-264-3901.
We thank you for your cooperation in this matter.
Sincerely,
Jackie Lewis
Emanuelson & Dad Inc

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