36732_DOMBROSKI, RICHARD_20031118

❑ CAMA / I" DREDGE & FILL ve
GENERAL PERMIT
Previous permit #
ENew Modification
[-Complete Reissue ❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name r' r f p r t]
'�L 1. os
Project Location: County r. r +
Address fir Ot/ 1 N f
1(-, 4 %�,
Street Address/ State Road/ Lot #(s)
City '�„
State d/ ZIP (
L -I 46
Phone # (> l9) `l e l ''1 c�
Fax # ()
Subdivision '�a•, l{ ��h ��; • S
Authorized Agent `w -1�
Z 1/,,, rlfc
City T 4u d c, { ZIP .'`,".IIII<7
ElCW ElEW
Affected
� PTA ❑ ES ❑ PTS
Phone # ( ) River Basin l'v� , 4, ✓�
❑ OEA ❑ HHF
AEC(s):
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body : 1 r, v V"C-tl f gnat /n(an /unkn)
C PWS:
❑FC:
(-
ORW: yes / no PNA
yes / .no Crit. Hab. yes / no
Closest Maj. Wtr. Body t, r Y' Cf
Type of Project/ Activity
r1i
►���
`/
(Scale: ti E )
Pier(dock)length—
Platform(s)fWr{I,
Finger pier(s)
Groin length
number
- -----------
------------ --
Bulkhead/ Riprap length
—7
avg distance offshore
11II
11, �. C !
i `L .S
C.
max distance offshore
\
Basin, channel
--- — -- — -
u
cubic yards
Boat ramp
�{
Boathouse/ Boatlift ; x
Boatho
i
Beach Bulldozingf�-
Other
�a
r7c2
�
Shoreline Length ' 92
I
SAV: not sure yes
ng M< r 4,
Sandbags: not sure yes
no
Moratorium: n/a yes
no
!
i
Photos: yes
no
?� i
Waiver Attached: yes
n_o
A building permit may be required
by:
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
/ 1 �
i,�r�,o•�r f:�
'G - s�•-��._.c
;�.�{-{,c - �<<� . nc, a,�<rl-�-,k• 1 ,cl-%t`s
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
414c. LG ,1r' , �/p & It s' c3
Application Fee(s) Check #
Permit Officer's Signature
63
Issuing Date Expiration Date
/ t,, .1-(,, 4 /1 -) it 1615
Local Planning Jurisdiction Rover File Name

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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

CAROL A. DOMBROSKI
RICHARD M. DOMBROSKI 5003
115 FLYING LEAF CT. 919-481-3208
PAY TO THE
RY,NC 27 13 DATE_ `�� 50-7936/2219
� - --
O DER OF
-DOLLARS
Hudson VaHey � �!8 �,...�
Federal Credit Unison C'��� 3�-7 3 Q
MEMO <
i
1:22 19793631:00000980031,00911■
500 3

10l30/2003 1E:26 2403847080 MC: PAGE 01
❑CT-39-20OZ C3:1i PM LL-C Y 252 72a Tn76 ¢.91
ADJACENT" DIPA AI'r+1 PROPERTY OWNER STATEMENT
(FOR A PIERIWOORING PILING.V80A7'UF 1B0ATH0U-SE)
I hereby Cerdfy that r own property adjacent to r �role. 's
(Name of property Owner)
property located at L.4 r Co wk
(wt, loc:k, Road, etc..)
Oli�lrr. rrGaV. �1i1 �Rr 1Ria.� r,+Ni TT
(Waterbody) (Taum andJor County)
He has described to me, as shown below, the development he is Propoiting at that location, end, I
have w ob]octious tam his Proposal. I undergund that a pierlmoodng pMug&'boatlffVWathause
must be set bsck aminirnum distance of M= feet { 15) from mar area of riparian access unloss
waived by me,
l d, a�ot wish to waive the setback requirement. NOV 17 2003
DESCROTION AND/OR DRAWING Oy PROPOSED DEVELOPMENT
(TO BE FILLED IN BYINDMDUAL PROPOSING DEVELOPMENY)
' %w-e- ' L

OCT-31-2003 05:03 PM DAVID.JESSE 3304831029
UMCC-31 16:59 Prom -Mill BoKsi Eto 20iT101185 7-111 P.003 R-502
-Sesse - F04 SSO zz f - 6 1.121.
P.01
ADJACENT RIPARIAN �PROFFK 1Y OWNER
T ATENENT
(FOR A PIERW0(
1 hereby Ce d ify that I own property adjacent to 2 i ��..wa �pr�bra t�kl _'5
(Name of propeti y Owrner)
property located at i !Ar * G � ► a ) _.._. .._
N.C.
s...
(Watabody)
Fie has described to me, as shntvrl L +njn , the develaptneat he is prcrpoai= at tbu twitiol
vt,4eO:ac,lle, trrrl; iz3s _K�.�l. ? c.aci xstand that a pirv'/maariu4 PU S�slbontiitl/ oathduse
�nrs: *c� a*L t,3e': a min�rtsju^� eistanre Of ftttecn fact (1 S) from my area of riparian access UUicsse"
vati'vea by M. NOV 17 2003
I 4"A wish do wgive the setback mquirarr 0t.
I to W&ive tijtj r,1_JJ a 'JZ-tcnjirerrnnt.
- - - DgSCRDP ITION AffWOR DJLW?DZG OF PROPOSED DEVELOPAIENT
(To AE FILLEp IN jqYIN2Iv1D r; _E PROPOSING DEYELOF.AZN';
t'g"`` �
---------T---------------------------/-- -Y-_ ��---.:,I"-; :-i7---
-?ttxLSr' :Fo,.x saf'k
Q S' P -w 49 ZSZ/77-8 7;7'&,
Print 5r'rype Name
-12.221S—L-
e1CphpnG
Date; 0

��IIQ IAA
INTRACOASTAL WATERWAY
mi v 17 200
PROPOSED PIER G NORTH
UNCOVER BOAT LI ZEBO
80' CORPS SETBACK
45'
6'
Aprox . mean high water lin
d
McAda Dombroski Jesse Property
Property Property
5 6 7
Sight Plan
Dombroski Property
Lot # 6 Gatsey Lane
Stanton Landing
GAZEBO Beaufort Township
Notes: Scale: 1°=50'
8' 1. Soundings taken from map prepared by Atlantic
Coast Professional Surveyors of Harkers Island
2. Channel location taken from map prepared by
the Core of Engineers
Proposed 6'x45 max. access to a 45'x8 L'
running with gazebo and two uncovered boat lifts
on either side of the proposed plat form