22418D - Dombroski

OCAMA AND DREDGE AND FILL
GENERAL l�° 22418 b
PERMIT
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the Co.astal Resources Commission
in an area of environmental concern pursuant to 15A NCAC '744 . 1200
Applicant Name lt 0 M S lv M b r U S V-1 Phone Number (075"08 ci- .--
Address 10 1 - 0 r`A 1d f ue' tk_e_
City CASi\c - +\AL rc State ►A '
CI) Zip a(51421
Project Location (County, State Road, Water Body, etc.) (c)n S 10 t„-) C 0(,L n It) cl ( L_Ur 13 )
Ckbesdkv', cL �kores �ir',ve) Se - qds rwr l _), C11 uJIi�-R
l
Type of Project Activity �t..AA) P, <- P��d F 1t� "t' 1
-A N() pi-NorC, '}-fnf\r, a bo Al s ma-, hrJ f cr>red) C(..) *1n is 541-Y•or}-u r
Mu-�t be. W‘4,-1n u\t,tAr C"; Prsr; Of rtc1 or rcr or-rr "Y,c& uel
* "F.ocoC Coves C 0 c-,r\ot M1vt,J for c.Or,d SiMr,.A u_St'
PROJECT DESCRIPTION SKETCH . 7 0 /�-1 ' (SCALE: )
h��etc 1c l Ki o T Tu
)\
l --�r'
Pier(dock) length I=1 U lc
x (c' w;de
Groin length
number
4 t 1
Bulkhead length
Co'
max.distance offshore
Basin,channel dimensions
IbU
cubic yards
Boat4amp dimensions
ii
Other Io7 k O�a Y f , r ,1,-
Other covered crli3rsh `� It f!O �/
i `� f v �' it V, y V
Co' x1ct Curvt - 4 V \V tr I \i' ,
94' LOT
Is
This permit is subject to compliance with this application, site - ��% /J'Kc�
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine, applicant's signature
imprisonment or civil action; and may cause the permit to be- i
come null and void. Q QO
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance. G � C
The applicant certifies by signing this permit that 1) this pro- (Art ( f ) ��'1i{ '��V J i I99C
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no 1 . I 2QU
objections to the proposed work. attachments �

u sNERA_I PERMIT COl\WUTER FORM
APPLICANT NCI QS�
ADDITIONAL NAI`ES:
_AEC DESIG: p T E l v D�%E.,OP A _0 2- PROJ DrSC: P - 12.
----bar 6) (Wit oniy-iare.I)
WORD'. Q v 16-fj'>c, Co "C., [o x I c
(Wit=3y lake.4)
m 12>c 22
1 AINT:
(Will wily vat 4)
DAT: 0t ) �( 00 03 II 4 •
(. oa v zk s) •
btkJ �&4
ACTION =IR4TION
DR T.R,Q�-�?: 8 f 1 ct « I. s I a c
CAMk MAJOR DEVE R.QU=:

DTIYIcION OF CO4ST4L M4_\4GEMENT ._
4D.T4 CENT RTART 4N_PROPERTY OWNIR\OTIFIC4TIONr\V47VFRFORM
Name Of Individual Applying For Permit: h 04 aeve h r cis 1,-'-
Address Of Property: i--6t /33 C i w: Lk $k6 r cS
o n ea-c/s Fe r-r-1 , Os/ow (xLez-/->,, / iC.
(Lot or Street #, Street or Road, City & County)
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, should be provided with this
letter.
I have no objections to this proposal.
if , , have oniertions to what neino nrnnoseli pleas,- write The Division of Coastal
Management 1-77 North Cardinal Drive Wi]minc1on North Carolina, ').5411-5 or can Q10 95-
-Q00 within 10 dave of re^'int of this noti Nose:tpons- is considered the came_as no objection
if you have been notified by Certified Mail
W 4TZTF,R SFC'TION
I understand that a pier, dock, mooring pilings, breakwater,water, boat house, lift or sandbags 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 most initial the appropriate blank below.)
r
I do wish to waive the 15' setback: requirement.
I cin not wish to waive the 15' setback requirement.
• NIcirm-A
,,,,,,,,,
S i Erasure Date ���1- r
I-tint Name NcDENR
7i -72 '- ?77 '
..- i, _ ♦I.':.:. A «.. (�,--;,- _ NO TP- CA.RO�INA pA •L� RT1NT OF -

DID icla_nF CQ _T T ate. , n
aNa•
Name Of Individual Applying For Permit: o046_5 l.-
Dôyj!osl�
Address Of Property: — i-o t 33
c,u/c_k .c{Zarcs
5 s —e(-FL Crt s l o a� .0
(Lot or Street #f, Street or Road, City R. County)
I hereby certify that I own property adjacent to the above-referenced property.applying for this permit has described tome as shown on the attached drawing} The individual
they are proposing. A description or drawing, with the development
letterairn�nsions, should be provided with this
_ I have no objections to this proposal.
r
C r o' o
QP '� 0 sm. P P r.
�Y� / re 7 - 9 lY^-
C nG P C
if VClll }la\ ' p nn n .. A
W 4 B
'FR c.E'CT1nN
I understand that a pier, dock, mooring
pilings, breakwater, boat house, lift or sandbars must be
set back a minimum dim ance of 15' from my area of riparian
wish to waive the setback, you the � �' access unless waived by me. (If you
mist initial appropriate blank below.)
I do wish to waive the 15' setback requirement.
�,,,,111 * wish to waive the 1 '
o setback requirement.
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•
f THOMAS P. DOMBROSKI
DEBRA LYNN DOMBROSKI 1.241 ('
101 R675-0895
CASTL�ENALD HAYNE, NCAVE. PH.28429-5396
3�1U)% _ I I 66-112/531
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NANCN OgN10N0 N& COMPANY Cnrw..un
S61 O CASTLE HAYNE ROAD
CASTLE HAYNE,NC 28429
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