74398D - Petrillo

XCAMA / DREDGE & FILL NO. 74398 A B C OD
GENERAL PERMIT Previous permit#
Ndw ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / f I �Q
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name o U" S f +i , %16 Project Location: County i S . c
Address ko�� 1 'll, _. S (. Street Address/ State Road/ Lot #(s) t I Z Tom^ V� ,
CityetW�^ SCA�tr, State IC ZIP1�"1O�
Phone # ) E�-tMail I ( 9 ^�' . i .� or. Subdivision
Authorized Agent uk� kk O A Ciry 0 ZIP a �pd�
Affected ❑ CWEW A ❑ ES El Phone # O River Basin r ,�
AEC(s): ❑ OEA ElHHF IH El URA ❑ N/A
❑ PWS:
ORW: yes / PNA yees�s/ fio 11
Type of Project/ Activity aA J f," c. �- A.P .-J roc. fit.
Pier (dock) length
Fixed Platform(s) T '�X I �/✓�_
Floating Platform(s) D x t t0
Finger pier(s)
Groin length
number
ho fkT -r V6 Al
Agent or Applicant Printed Name
Signature Please read compliance statement on back of ermit **
,10
Application (s) Check#
Adj. Wtr. BodI (na_ t IreV unkn)
Closest Maj. Wtr. Body A( LU W
( t�
(Scale: Q -TS )
❑ See note on back regarding River Basin rules.
1:
Permit Name
C Nt ice/ R
Signatur
Issyi Date Ex iratio Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Louis Petrillo
Mailing Address: 1067 Miller St
Winston Salem NC 27103
Phone Number: 336-671-1015
Email address: [e-mail]
I certify that I have authorized H5 Construction LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Demolish old dock
Build new dock, ramp, and floater
at my property located at 112 Tuna Dr. Holden Beach NC 28462
Br nswick
in U County.
I furthermore certify that 1 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 0 r Information:
Si re
Louis Petrillo
Print or Type Name
Owner
Title
12 /19 /2019
Date
This certification is valid through 06 t 01 /2020

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JOHNSON IMPROVEMENTS, LLC
114 TUNA DR. O
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WILLIAMS LEE ET ALS
110 TUNA DR.
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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so, that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed to:
lc;1VILI
V�
s-
A, §iQpature � Agent
x 1 p Addressee
B, ecei ,ed by (Printed Name) I C. Date of Delivery
Is delivery address different from item 1? ❑Yes
If YES, enter delivery address below: ❑ No
3. Service Type
D f rnorny mw1 E"Pr��
[I Registered MaiIT"
IIi lli �l
I l l'll III
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❑Adult Signature
D Adult Signature Restricted Delivery
❑ Registered Mail Restricted
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9590 9402 4906 90! 2706
❑ Certified Mail®
❑ Certified Mail Restricted Delivery
Delivery
Delivery
❑ Return Receipt for
Merchandise
Collect on
D Collect on Delivery Restricted Delivery
D signature ConfirmatlonTM
[3 Signature Confirmation
2 q jrte NuRtfler fT( ifpL.ff[1._ _Rt S@NICe label)
— i Maii
Restricted Delivery
7018 0660 0000 7027 0868
j Mal Restricted Delivery
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Domestic Return Receipt -.
PS Form 3811, July 2015 PSN 753o-02-000-9053

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Ne*+�'°er� #wd I own prav*rtf► to Louis W d Provr+tl► Orw»h z
lie
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on Naas^ s..a` eoa,►i
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n�..vd�'"c''"" in a� a
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aaJ►MI n of P110P0ew -
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urtderstsrtd that a pier, dock. moonnp Pups. bosh ramp. breeikw W. boadsauk lk Of Wdn.
mum be set back a minimum dfetatroe of 1S *am my am of fiparien access ml n
me. (if you wish to *v" the k you rsNsst i >ha.
i do wish fo w Ww the 15" sed)K*
i do not wish 10 wai+re the 16 se m&
Signalwe
Louis PWnfid
PW 10�67�I dNW SYrwo NC
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12-19-2019
TIM
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Lte J�Wdiems
Print or Type Nerve
A1918 Riverside Blvd
L m&A&",SAC 283W
Telephone Nurnber / em d address
Date'
'VW for one ca%ndar yaw altar siD ubxe• (Revised Aug. 2W 4)

Date Received
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