Antonellis, Gerard

i
'CAMA / 71 DREDGE & FILL
GENERAL PERMIT A B C D
Previous permit #
New `Modification DComplete 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 I SA NCAC
LAules attached.
Applicant Name i`ICI y Project Location: County
t ; .
Address t t >ts_ 1 Street Address/ State Road/ Lot #(s)
City t`' ,^E State J ZIP- _
Phone # ( ) ���~� E-Mail Subdivision
Authorized Agent' City ZIP
Affected ElCW ❑ EW ❑ PTA ❑ ES ElPTS Phone # ( ) River Basin�1
❑ OEA ❑ HHP ❑ IH 1-1UBA ❑ N/A
AECs: a r- }
() 1-1PWS: Adj. Wtr. Body` I,(WI na /man /unkn)
ORW: yes / no PNA yes /,r
Type of Project/ Activity�'ti
Pier (dock) length LO f%
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length `f
avg distance offshore
max distance offshore—�
Basin, channel
cubic yards_ `f
Boat ramp
Boathouse/ Boatlift
..0
Beach Bulldozing
-X
Other'
m
Shoreline Length
SAV: not sure
yes /no
Moratorium: n/a
yes no
{
Photos:
yes no
Waiver Attached:
yes no
A building permit may be required by: ,1 y j(/J
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
J
J .M
Application Fee(s) Check #
Closest Maj. Wtr. Body t-" '(Y] 11 r-gli,
�j ' P
(Scale: )
[] See note on back regarding River Basin rules.
r
Permit Officer's Printed Name
1
SignJuFe
Vd
Issuing Date Ecpirati n Date

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:
C 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
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)
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement.net/
Revised 08/27/14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify► that 1 own property adjacent to "" /Y�Gt L,lC .is
property _ / C/00 S7 1 /�� r Game of P arty Owned
ro located at
[•n
iyek,
(Waterbody)
(Address, Lot, Block, Road, et��
in C t t Y0, 017 N.C.
(Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal_
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing;
Y �horjAJ
lilatkwa ; 5 �
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent P InlEonnationj
Signature Signal ire*
Print or Type Name Pri or ype Name
Mailing Address Mailing Address
City/State2p City/State/Lip 1 ��
Telephone Number/email address Telephone Ntim� r/email address
Date hem
"Valid for one calendar year after signature' (Revised Aug. 2014

From: Jerry wntonems [e-mail]
Subject: RE.' DocK Project
Date: April 5, 20 i 6 at 2:40 FM
To: branai irtooertson [e-mail]
Hi bran
Yes. you may act as my Authorized Agent it I am not here.
believe i only have two neighbors, one across the street & one next door.
)u have anv deiav netting those back please let me know. They are all
great people & should not be an issue.
Thanks Brand;.
jerm,
Jerry Antonellis
F: 800.310.3144
[e-mail]
-----Original Message -----
From: Brandi Robertson <[e-mail]>
Sent: Thursday, April 05, 2018 2.36 PM
To. Ion. net
Subject: Dock Project
_ws Mr. Antonejlis.
I sent out notification forms to vour neighbors informina them of the
proposed project. which is part of the permitting process with the State. I
am nooina to nave the adiacent orooerty owner notimatton terms back nexi
week When I get those forms back from your neighbors i wiii set up an
aDDointment for a site visit with Mr. Connell. In the event that you would
not be available to meet with us I would like to get permission to act as
your Authorized Agent. This would allow me to obtain the Dermit on vour
behalf.
Please respond to this email confirming that I may act as Authorized Agent.
Thank vim:
Brandi Prescott Robert
B Prescott Marine Construction, LLC
252-249-0149
brandiprobertson @am ail.com
01