87384C - Tarnowski, Stephen

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o1*01`°"Sy, RCAMA ❑ DREDGE & FILL NO. 87384 A B C D'
h
y = GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length )
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
I
1
Total Platform area
i
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
3
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards'
...................
Boat ramp
$......_ .w_.
Boathouse/ Boatlift
Beach Bulldozing-71
Other
3
3
SAV observed: yes
3
no
Moratorium: n/a yes
no
Site Photos: yes
no i
Riparian Waiver Attached: yes
no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:;
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
.r
Application Feels) Check #/Money Order
Permit Officer's PRINTED Name
Signature
r e�
12-1/
Issuing Date Expiration Date

1�°iCOW41 ❑CAMA El DREDGE &FILL NO 87384 A B C D
2 �y GENERAL PERMIT Previous permit
Date previous permit Issued
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
3nurenne Lengin
Access Length _
Pier (dock) length
Fixed Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no m
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" �)
Application Fee(s) Check #/Money Order
Signature47')
Issuing Date Expiration Date

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� . DIVISION OF COASTAL MANAGEMENT'
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
C E R T F, . _ 81 !RET'URN REQQEI RE L EST Q or Hj INJL QEELIt EERY
(Top portion to be completed by owner or their ag nt"i
p ei�er�t°j �`.,�)iune,r,
reµ
;"'Sd :d l =- s s of Property, ... ...«.«,�.._.�,...«.. ...v_. ..... �-
✓^e
p1
-'1 M .,aaafit+ 'u
("� httiC
C r� 'iy iEt.' z'�? ���ai:�`;
km
y Agent h o i P!"m+y2
Name, "�'�... """ � , '°' .sf•a�'«'^a^"e-'"�` a.^'"�".t
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,p f e
ADJACENT RIPARIAN PROPERTY OWNEWS CERTIFICATION
ar yr n � r} ed i t Aid' cen Prep Owned°
^h lF"i P:.,"'>�^ {f'... r rri the C' y'>. f ce p Sao p I .`. f ne {� livid ie.<f wi E.i i,+4y. t E I _
h ere by Cep fV 411 t t ,. f p �r�;r 4EZ C et €t a t: ;� a�is1� C �
#4
F _rx ri the. ':ifs' y., ( E�y �^k �'3L}•w•tr �Y ';.!.F }•.15Jvt.r �'":..
ia,e mit le cr. .r S^f to :;.: �s s ow: on 1 e. 'ai aaa ti�ei'd drawing, .al e 4ie �i?i..s t✓,: >>,..., _ .s
s. must •^ provided with this letE et
uesq.-_[IyEo1 €ra.
:. t ��} '"' `F T_'.`.s 3.f �"" {'I IF '! ^�3..e� - i 3.f ;..,s .L^i`` a Ft.o'b}e' 4.ons Sw h. t.. P€'� Lt... c,
�,,,.'". i D O !N i = ' :s �( P"" � �f �' � t: -.. n to t �v°` j.T i is :. ' ! . „�,.__....................
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Tf `U have objections to what is being proposed, you must notif', theN.C. Division f oasc,
Management (DCM) in writing within 10 days of receipt of mis notice, orres onde c ��r��c� ��
mailed to 40 Commerce Ave, Morehead City, NC 28557. DCM representatives can also be contacted
at (2 2) 808-2 08. No response is considered the same aS 00 abjection if you have been notified by
Certified ,Mail.
WAIVER SECTION
{� EE��^y F pier,
�Ctr'�I�+ ^'y`; f""1 u'l Si PF � p r£.^'xnnp, breakwater. boat'..Ouse.4 1.f't
w d rs-:;.-.n t��2 any proposed E•. `..n tu£'t. ni c.o Ig i..:. ..z'�, s.� ..�a�jt �^ '3 Y^� less
tyj y _ 4
+?• F 3 I fj � V LI r .sh✓aria # a. w4ess ur, lk.:ss 4E SwLitle SJ`i C.
aro n L;:,? b s-,et t C mtinini i s @rice t^:: }J Crr }} . yySt S F ap
b > ?'x r f T!' 3-� 6 i... L i ,j j h f L: y S ' Y3' T h e. l b a y Va/ l S F 3 Li s #�. a�i i F i
t`. Y'•';�§ '"Y^`s'"k,,4"§1 :I1..+_ti .ma`s i`a tf tw w..,it.,:... ar`t
Ins to-q nct, a �o bulkheads w. ri
the yG"E ys ?.s fpQr'w'?priaate . lalire! : f .f
o'"° T.' ?s n ' e
td#.fci` C'.�i, 3�"f,..3f.... 3 ijr
f
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TypePrintecne cP
41
Mailing Address ol
�1 r
ARPO's email:
et s � ; .. � waiver is valid for up tt, one year from ARPO's SignatufeA
' 21

N-C, DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATION[WAIVER FORM
I DELIVER`(
CERTIFIED MAIL ,.,Rc:TUEC
RN REIPT REQUESTE_Q_0_rH_A_N_Q_E__
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Propterty: 3
Mailing Andress of Owner,
Z
wners emal: owners Phone.#'
Ol
e#- "2-
Agent Phon
Agent's Name,.­/l -7
Agem's Email.
ADJACENT RIPARIAN PROPERTY OWNEWS CERTIFICATION
e core plei; egj_b�e �Adjacan.t_ rot)ertv.,0caner
'1.
hereby certify that I own property ad scent totheabove referenced property, The in iv?; appiving for this
aiced drawing, tree developi-nent they are proposin
permit has described to me, as shown on the attar
descLigj�,tion or r it
,sJons, qiust be_2rqyided w—Ith .thisletter.
T have objctions tars proposaL I DO have ;obje tions to thi's proposal.
I DO NOet
ou have objecd n
to what is being proposed, you must notify the N,C. Division of C;�astal
Management (DCg) in writing within 10 days of receipt of this notice, Correspondence should be
mailed to 400 Commerce Ave, Morehead City, NC 28557. DCM representatives can also be contacted
at (25�) 808-2808. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION se, lift, cr
cooring pilln.-gs, bcatranip, breakwater, bo@t1hou
understand that any proposed pler, doc k, m
groin'must be set back a rninimurn, distance of 10`frorr. my area of riparian access unlpsss waived by me
'this does not apply to t bulkheads or dprap revetments). (if you wish to waWe t1he se*back, vou MoLi=
the appropriate blank below,)
ome/ail of the 5' setback
I DO wish to, wa.1ve S 0
Signature of Adjace,nt Ripatian
-OR-
I do not o waive me t
wish t IS setback requilrernent('Hjitial the blank)
i .
ty Ow,
Signature of Adiacent Riparian Proper,
TypedlPrinted name of ARPO:
.71
J
;7c
Mailing Address of ARPO: ,
le
ARPO's email- Phone#:
Date, *waiver is valid for up to one year from ARPO's Signature'
R.410sed Juhl, 2021
1