Dobrowski, James - 84285C

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tt>�AMA [ 1 DREDGE & FILL a IT - 61)
Previous permit
f GENERAL PERMIT Date previous permit issued_
[J ew ]Modification
Complete Reissue ❑P�rtialRe{uue
A x thorixcd U{y Jim St\at of Nw)tb anlhm, Depu nnenl of FnnrWxmemal Quarry and the Coau ficsow aes Camm�zSwnin an ar � of enYvonmenW cuuc.n pauoznt m:
15A NCAC .\� ' Y O_ .__.__ rj Anles alrached LGonctal Pui At Rile,availableat the fol..g Joe gnvdgAt><Ji,,rLCAMArytg3
AppUcaneNa A thorixcd Agett
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ay
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i j S, cl (;4 j .. ._ TANPAMNEUSE/BUFFER(circle one)
ir,. hof See note an back regarding RWer Basin rules
See additional notes/cndi6ons on back
JAM AWARE OF SYATUTEScCRC„RUlE3 ANDCONPITIDNS TNAT AppDTO THIS PROJECT AND REVIEWED COMP_i"5E�{NC.`)S�TA7�E'M NT. (Please initial)
Pe
s-- nn)e Ricer 5 P IN7E Name
Agit9t APP3( tf J(IN{ tNanfe r i/
aWn ^{lea{o roadrnmPirmue atttement oil tack of permit" Idar re
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rt

C57e
AMA ❑DREDGE & FILL N9 84285 A s(TNERAL PERMIT Previous permit
Date previous permit issued ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the Srpte of i orth Carolina, Department of Environmental Quality and the Coast esources Commission in an area of environmental concern pursuant to:
I SA NCAC �Vy'jl '41 i 2U U ❑ Rules attached. General Permit Rules available at the following link: www.dea.nceov/CAMArules
Applicant Name
Address
City � \7.i
Phone #, f(,(�''«
Email 11 X )
Type of Project/ Activity
Authorized Agent I
Project Location (County):
Street Address/State Road/Lo # s)
U
Closest Maj. Wtr. Body
Shoreline Length
Access Length
a ^
Pier (dock) length ---
Fixed Platform(s)
1f1L
x �,
J10 �)
�_
Pq 1 ' k
1 pp
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/A
Bulkhead/ Riprap length
Avg distance offshore '—
Breakwater/Sill
/
Max distance/ length
q(J
Basin, channel
Cubic yards
Boat ramp
VI
Boathous oa ' � 1_
1
L�/ f,V�
rif("e
Beach Bulldozing
Other —�
SAV observed: yes
'Im
Moratorium: n/a yes
413),
Site Photos: yes
101)
Riparian Waiver Attached: Cqm
no
A building permit/z000nnn1���,ng p(er�m/it��1n�a1y
be required by:
0
Permit Conditions '/ lJl rl
Vl I�7I1� IAM_
n
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND F
Agent or Applicant PRINTED Name
_ Z 44-
Name
(Scale:W-9
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature **Please read compliance statement on back of permit** Sig re
I ",/Y) r a, '51112M 3 a � I I
Application Feels) Check q/Money Order lssuihg Expiration

❑GAMA ElDREDGE & FILL N9 84285 A B c D
Previous permit
GENERAL PERMIT Date previous permit issued
Q 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:
I SA NCAC ❑Rules attached. ❑General Permit Rules available at the following link: www dec) n<goyICAMArules
Applicant Name
Address
City '"
Phone#(_)
Email
Affected ❑ CW
AEC(s): ❑ OEA
Male
DEW ❑PTA
❑IHA .,❑UW
f _.
PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length _
Pier (dock) lengtl
Fixed Platform(s)
Floating Platform(s)
ringer plertsl
iocai rianorrn dren
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards "-
Boat ramp
Boathouse/ Boatllh.
Beach Bulldozing
Other
SAV observed: yes no !
Moratorium: n/a yes no
i -
Site Photos: yes no i-
Riparian Waiver Attached: yes no i... _.._
A building permit/zoning permit may be required
ZIP
ES ❑ PFs
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adi, Wtr. Body
Closest Maj. Wtr. Body
(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 Permit Officer's PRINTED Name
Signature *'Please read compliance statement on back of permit"
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 'J Qrr'eS Dabrtwsl-
Mailing Address: Ao/ b/c/ l.%,-//wee LA--'
r&':ckt f NC '-;2tr4(OD
Phone Number: CM4 - 0, 0 - / V& y
Email Address: Uer;Zc,v : Ile"T
I certify that I have authorized Jl.vtl A Zco+ (?Z C-/-Oz
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Move CrF ILL""
ii
at my property located at 110) 018 1 , (ASX L(N , oA:I'aQc (:G
in GvS� County.
I furthermore 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:
6 Signature
T i
Jf1n-es /JJ/p•�wS�t
Print or Type Name
Title
y I 2 3
Date
This certification is valid through -I__^l

"M�Mi wl
Its
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illg Ilk
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it I
i 3 i. p a �yy7 0'� 7A 6lyYp�i� . 4

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: II Zkll we S -D-Ob u , o�t1ca /�
Address of Property 1 ©« Lt (1 �'�'�, l t-t--• &rc6c NC 2�t1to�l
Mailing Address of Owner: ) ( 9 � � t R try /Y TWS`�', / —n(( 2 n 6 ca
J /
Owner's emailjJo6e^a 6 ,A t ." i 7-cr-t O'Owner's Phone#:
Agent's Name: Agent Phone#:
Agent's Email: 7JO41bu.SGa U V i "kav �
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner}
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
descdption or drawino with dimensions must be provided with this letter.
xI DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
matted to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been nofiffed by
Certified 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 15' 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) n
I DO wish to waive Someiall of the 15' setback Jh -7 _ /1 /I. .,
Signature o"f Adjacent Riparian Property Owner
-OR-
I doAot wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
"waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner .Jf�trn 5 +
Address of Property: ) i I l�i.S i}` �4tst. �..� N (_, (V yy6L-,)
Mailing Address of Owner,
r
r 'T$ r h L 2Pf 6
+ eT ?/a _(;-0 VY6 `f
Owners email.Ti -1 try SfC �F tf¢riZyv + Owner's Phone#:
Agent's Name -
Agent's Email:
Agent Phone# -
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
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
descri tion drawin with dimensions must be provided with this letter.
i DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to whatisbeing proposed, you must nomy me mu. urvsron U+
Management (DCM) 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 [phone]. No response is considered the same as no objection if you have been notified by
Certified 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 some/all of the 15' setback
SigrArtule of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO: L , _ -f\C C V - (,^- V Lt.. + v r r I + " J �-
� .�
Mailing Address of ARPO: 3 / 1 �R Y " YA C _ �.0`- -_ i-( /'f 6K LA— ` " ""' d r " \
ARPO's email:lw�
1ARPO's Phone#:�Q�' 35- 23
CX r,
Date: h for up to one year from ARPO's Signature'
Revised May 2021
f� 2W2

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ] c T/a"S :DGhC0LJ1 f r
Address of Property
Mailing Address of Owner. Ji LL-- 11 Try sn,( PAbc& A(( oZ �'tfi cJ
^t 1
Owners email:��ci)lb &� t! g Zc.- 'Owner's Phone#:
Agent's Name: %t.�(__--r`�^--'Y''= Agent Phone#:
Agent's Email: V P1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
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 vrith this letter.
100 NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must nomy me N.C. urvIsron or coastal
Management (I)CM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead Chy, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notfed by
Certirred 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 15' 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 mlist sign
the appropriate blank below.) ,
I DO wish to waive sometall of the 15' setback % 7 _ _ // /J. _ a .
Signature of Adjacent Riparian Property Owner
-OR-
wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phona#:
Date: _ "waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or. HAND DELIVERY
(Top portion to be Completed by owner or their agent) orT
Name of Property Owner .Jn:r4
Address of Property.
Mailing Address of Owner, i �) G 1 c( l+` 1 �Aap (�"" NTg r L 2 ("
aT it o U
OwneYsemail�.Td�;�r'try S4.lPVjQ�'Z�'""'f"rOwner'sPhone#: �
.
/Y6 Y
Agent's Name:
Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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
descn tion or drawin with dimensions must be provided with this letter.
I DO NOT have objections to this proposal. 1 DO have objections to this proposal.
it you nave ourecuvna x-, -
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should 6e
mailed to 400 Commerce Ave., Morehead City, NC 28557, 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 any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or nprap revetments) (If you wish to waive the setback, you must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback }� - � < 1r
low
Sig fure of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO: (.. Z-rr �S f I r 4 S-- v vim- v i r I r• I I
�✓
Mailing Address of ARPO: �) (P V o k_ Y1 C_ Lo, 2 cra,
ARPO's email: s u 0�1 ARPO's Phone#:itQ� `
{ nfi'c cc�, CX r�
Date: a. `waive is ya{ld for up to one year from ARPO's Signature"
Revised May 2021