87557D-KOZIAK

`°"Sr ❑LAMA ❑ DREDGE & FILL CD r N. 87557 A B C (D�f
Previous permit {'` "" 5 -�t�' '7
: GENERAL PERMIT/J/ -,
Date previous permi issued I
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue<� Gf
As authorizedbythe State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environ ental concern pursuant to:
I SA NCAC A I h ' 1, k 60 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgq.nc.Yov/CAMArules
Applicant Name MC.,Pnk ?071 dc
Address 7Tj rj_ C., its 'D (' W...,�.
city f4 14 State ZIP g58S 01
Phone # � { ) 6
Email !0' 027k ir
Authorized Agent P6 Ld,(r !%`
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision r^ � "`)'n/ k-r `>
City bti j EyC7Y"-� zip o c
Affected ❑ CW ❑ EW PTA ❑ ES ❑ PTS Adj. Wtr. Body JJ ) /''411man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA,ye-lbo y
Type of Project/ Activity y' v7 ' S6/1 fr- n11
Shoreline Length ' J 1 S 1
Access Length " I-Aty, �`i
Pier (dock) length "' J
Fixed Platform(s)
Floating Platform(s) I U k A 0'
Finger pier(s)
Total Platform area goo sF
Groin length/#
Bulkhead/ Riprap leggth
Avg distance offshore!
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp r
Boathouse/ f3oatliK
Beach Bulldozing
Other
N
"t V
T
4p k�--�
� h
(Scale:
'/C 0 W W tp -41�
4
yr I
l ri'-►
W� Jrt►t.}
Slors
_- p�1tq�
Dr-
SAV observed: yes a }ejq i!i oi,�t P I f
u
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit maybe required by:
Permit Conditions`-f
7• ii i rfci 64
r Y i
h<<('�i'�� �r3v1C� a ic.) i/ ve.4(r C� '.,,1
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND
Agent or Appli= Natpe
Signature "Please read compfiance statement on back of permit** -
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• �;)�;;�`-�
Application Fee(s) Check #/Money Order
LWE
e+�fi� bk,ll�i
a4M
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
STATEMENT. (Please Initial)
� ( r'!
Signature
Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar - Pamlico River Basin Buffer Rules 1-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

a""% .VCAMA ! DREDGE & FILL ,1" �� % -:� / A B C P
GENERAL PERMIT Previous permit �" 5 3�
` Dace previous permit ued
j New ;- Modrfication ElComplete Reissue [�) Partiaens
l Reissue
As saftnitied by the State of North Carolina Deparunqu of Enworvraxa' QwYry and the Coastal ROU"ea Cormti imir it an a,ea n' ernrorsrxr+tal to'Kem pusuax w.
I SA WAC Q�1 Il!,� ---- [J Rulers -n-twd U GO—i Hermit kic- aywimbie nt the fo+a vnj brit:
Apprcant Name J i A.,choraed Allont
Address 3*Iq �tn1►�t _ Prolertt Laouor (C-oko-ty).
Ury tk Sate 1Q.-_ - _ --- ZIP _-_ _ Str«t AddrtsOme, Rnad'La M,sl ---------__— -
-A a �rQc�t�
frnwl 'G1I�4 Subdtiisror �ou►r+^t5 —
--
Car —as
r - _
Affected UCW dEW ( PTA
AEC(s) i'l OEA ❑ INA ( J VW
ONW: W46 PNAO-
Type of Project/ Activity
Shorerlr+t lanai. 1
:8
Atxeu tc h �,t
Per (docks length a'3d t"�i+w EO IA-
F iwd PlalWrrr>Is) �Q t
horns Pb4form(s)
Flaw piefls)
Total Plrtlam area
Crain Iry t%f*
dukrtwad/ Rrptap I h
—j
AvR distance oils -ire
Max distance/ knath
RA1in, rrtanewl --
Cubic ►yard!
Mar ramp
I
troethoute I
aeacn 50doiinR
Other
SAY obsrr rwd Q
Murdtoriurn n,ra
Sir wrotos ,•.
Riparian Waiver Alidchrd wit
A b4�+dnl twrmit/lrn�1g .rrm� fit /TYV be rea
rrowmil canoditsars _ � �N _
as PTS A41MOr. Sod/ --w it
U sAMtu► U lM Oww ?%. wt, aao, atwhl
--c1—SJrp
4
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t
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� 1 k� YIt� K0'j� P I lv. t+itti t pIr �
_ nvr�'urk)
(Scab:
i�tf+t�} wuftiyp�l
1 4AS
Qpa
?ua ❑ TMIP�WMEUSFJBUrfEN (tuck anal See We on uatl it!&ar" River Saur runts
>>'� K +"'t• • Set adatfor O notot/rOndOons on back
I AM AWARE Oi STATUTES CIIC RULES AND CON99.0- MS THAT A ty To THIS ""2* T ANO R[ WED COhprItANCE STMEMENT,
K A✓ a McP►� rt[�
W Applicarvt PRINTED Name Pt t er MINT Nat
-k of tt�
Plydsr rani 1 u stater*..[ on !fa p
a/Morn
APpkcatim frrl�I i Check O del bstirti Dal!
(Please Inititl)
314 �
Lx(.rratun Da[r

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION

1/11/2022
*Drawing Not To Scale*
PNA: Yes
1 IN
N
2O' x zo' Gazebo
(Dripline 12 x 12
io' x ao'Floaling Dock Dimensions) Boat Lift USACE Channel Setback
-- - - - - - - - - - - - - - - - - - - - - - - - - - -
Depths @ NLW ` 1
5a6 PM on 1/6/2022
1
�5 1
Wrightsville Beach +0.75' @ q:;oPM NOAA
Preliminary (Not Verified as of i/7/2022) 1
Springmaid Pier SC +o.86' @ 4:24PM NOAA 1
Preliminary (Not Verified as of 1/712022) 1
1
W aterbody Width: -qoo'
-8 r' to USACE Setback
1
1
6' x 74' Pier 1
1
1
1
1
1
1
1
1
1
1
1
Coastal Wetlands i
Proposed Bulkhead iii' 1 Tie in hb g
Coastal Wetlands 1
Shoreline -ioo' bulkhea exts
7 Pro a Return w' all (-3.5�)
Existing BulkheadW Bulkh ment flagged —P/L
r/6/ it ge ribbon a� S
P/L ags landward ovf,elv
VV,,�sgs�Jb/
t j;�� (Frank Hippel)
(Kloeppel) (Joe Koziak)
2745 Pinecrest Dr.
2749 Pinecrest Dr. 2747 Pinecrest Dr.
JOSEPH KOZIAK wticv.•o
r7 E MISSOURI AVENUE. UN,T n 204
PHOENIX. AZ aW,2
„ 7+HN 2 D7 2 o Z. v
$ 600.00
CHASE �► _.__-__�,r5[c:, p
1�14 - A... *A
COG &0923871: 7203531 2211-
0 204

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELNERY
(Top portion to be completed by owner or their agent) .
Joe Koziak
Name of Property Owner:
Address of Properly: 2747 Pinecrest Dr. Southport, NC 28461
Mailing Address of Owner. 3719 E. Sells Dr. Phoenix, AZ 85018
Owner's email:. [e-mail] Owners Phone# [phone]
Agents Name: Ben Brink (CPG) Agent Phone#: [phone]
Agent's Email: [e-mail] .
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by, the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying far this
permit has described .1o. me, as shown on the attained drawing,, the development they are proposing. A
dP_serinfinn nr drawinn ith r1knoncinnc mint ho nrnvidod with this loltor
1 DO NOT have db*.bons to this proposal. I.DO have objections to this proposal.
K you have objections to what is being proposed, you must notify the N.C. Division of Coasts/
Management (DC"Jn writing within 10 days of receipt of this-notica.Correspondence should he .
mailed to 127 Cardinal Drive EA, 'WIImington, . NC '28405.3845. DCM represen6rives can also be
contacted at [phone] No response is considered the same as no objection.if you have been
noticed by CertiTed Mail.
WAIVER SECTION
I understand. that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, Or.
groin must be set back a minimum distance of 16 from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (if you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive someiall of the 1 S setback
Signature cf Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 16 setback requirement (initial the blank) 'M K
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO• Kirk or Denise.Kloeppel 2749 Pinecrest Dr. .
Mailing -Address of ARPO. 42247 Castle Bridge, VA.20148
ARPO's email: d2ka'dkmk@a0l"m ARPO's Phone#:. [phone]
�7 Date: 7. /�), lo;� waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N:G: DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN 0.ROPERTV'01N14ER NOTiFICATIONIWAIVER FORM
CERTIFIED'MA1L ••RETURN RECEIPT REQUESTED. 6r HAND DELIVER1f. .
(Top portion to be a�ompleted.by owner:or their agent) :..
Joe 1C64ak..
Narne of Property Owner
Address of Property:
2747 Pinecrest Dr.. Southport; NC.28461.
maimm, Address.of.owner
3 1'9.E. Sells. Dr Phoen
ix..
AZ 85018
04ter's email:jkozi*Amsn.corri Crier's phcxre# .480-254=8530
Ben Brink CPG 910-302-.5725
Agents Name: i ) : , Agient Monew :.
.Agents Email- [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S.CERTIRCATION
(Bottom yo¢tion to be completed by the �Adiecent Pronertvbwner}
.1 hereby ceifify that l om.prcperty adIpcept to the above ieferented property: The individual appWl for this
permit has described tm me, as shown, on. the -adadted drawing;, the development theyy ire proposing. A
des - fion ordrawin ' with dimensions must be provided With this letter:
as have ojettions:to this proposal: - 1.130 have objections. to this proposal;
'lf you have objecdotns to.what is being proposed!; you musr norify,'the..N.C. Division of'Coastal
Managetnent (DCA9 in writing within 10: days. of receipt of this botice. Correspondence should be.
tidied, ro'27. Cardinal Dfnvb Ext, IAfi�oingrati, .NC:284f,-384& DCM represenraxives :cart alsp. he .
contacted at [phone]L No response is considered rhe.same as na:iabjecrion if. yeut have f eeh.
notiFed by Certified Maid
. . . . . WAIVER SECTiON : . .
:1 understand that any proposed pier, dock,.imooring pilings„ moat -ramp, breakwater, boathouse. Plat, or
groin must be s6t•back a minimum distance of 75 from. mY area of riparian access. unless w&ed by me'.
(ttris does not , ly to bulkheads or riprap revetineits). (if you wish to waive the.sethack, you rnust.sinn .
the apparapriate blank bel6w_)
D(� v�ish. to waive sorrreralP of the l a' seli�atlt . •
Signature iYAdfacent Riparian PraFperfy OrVrter . .
-CQl
a :l.do nat.%rsish to•walve'the.1S° setback re irerrient [ 'tial the blank]
Signature of Adjacent Riparian Property Owner:. _I
TypedJPrinted name of ARpO� Frank Hippel , 2745 inecre§t Dr-
Ty
Address:af ARPO: 70 Todd Dr: N. Glen Head; NY . 11545.
:ARPO°s email: f hippelefi@,rbail.com . ARPO's phone#. 718-366=0777
Date' 1. ZZ , vraiver is valid `for up to one.yser:frorn ARPO}s Signature*
�? .. :
Revised July, 202f

1'CAMA v' DREDGE & FILL
9 85S36 A B C l./
permitPrevious
GENERAL PERMIT Date previous permit issued
V lew U Modification [) Complete Reissue [:]Partial Reissue
As authorised by th1e State of North Carolina, Department of Environmental Quality and the Co ul Resources Commissron in an area of emnronmenal concern pursuant to:
15A NCAC Rules attached.eneral Permit Rules available at the Following linkviww den rx eov/C6P4Aruls!
Applicant Name h Ft Authorized Agent ,S/[_
Address 3:711 _ A k. ay�r,Project Location (County) 04 r e.iT it
city 1_ [11iriCllX State e1 ZIP . QStreet Address,(State Road/Lot #(s)
Phone #t 4 w
Email ice�;n sr Subdivision C, r s J — City SO k-1V1 Pkr4--- ZIP op
4 j----
Affected ❑CW EW PTA ES OPTS AdI Wtr Body --fff WW rttaryUflK)
AECO) OOEA INA UW WIMA PWS Closest Mal Wtr Body _ —__�—
ORW, yes PNA Q?no
Type of Project/ Activity ' 1
Shoreline tength" jDS / '/
Access Length~fiV"Poliij_13
Pier (dock)length
��vDsk
Fixed Platform(s) ajx10'
Floating Platforms)
Finger pier(s)
Total Platform area —O SF-
Groin length/a ______
SEED Ripraplength�
Avg distance offshore A,pymin-1AI/
Breakwater/Sill It `
Max distance/ leis h
Basin, channel
Cubic yards
Boat ramp _
Boat i 1 '
Beach Bulldozing _.—
w5tm
wti" hL X(";jV6wlIf!5
Other
kr/ V2,
1 \
W
Slip
I.Ml
SAV observed yes ri oset! fQ n-fiq w B
Moratorium n/a yes — ill T'
Site Photos yes /} r /n �I Q t ��� y►
Riparian :Vaiver Attached yes (� �`T I p `
A budding permit/toni ermit ay be required by
Per it ondin y�/VV /�� �,w (J----
L
VIM
bWE
�VSd
4A5
u PPel
TARIPAM/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) Mb
Age t or AP I cant PRINTED Name Perini fh--rJJer's RINT D Name
Signal " I mpbance statement on back of permit" 5igna_�j����
ApplicationFee(s) Checkll/Moneyorder Issuing Date / ExpirationDat

Date RaceNed
Data Deaoalted
Check From Name
Name fPermh Nokter
Yendor
Checknumber
Check
amount
Permit NumheNCamments
Rees/ t m Re/und/Realloeated
Cdumnl
Cdumn2
Cdumn3
Col-4
0o1umn5
Ca/umn6
Column?
Celumn9
Column9
11/14/2022
McPherson Marine
Benarz
First National Bank
4028
$ 200.00
GP #87558D
PA rct. 17746
11/14/2022
McPherson Marine
Koziak
First Citizens Bank
5609
$ 200.00
GP #87557D
PA rot. 17745