67985D - Fontanini

LAMA / ❑ DREDGE & FILL /C� 4---
permit t 985 A B
'IENERAL PERMIT 1 �� 17 Previous#
'New —Modification []Complete Reissue Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Name �� �h �}fR Project Location: County
Statek, ZIP
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❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
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Project/ Activity
tform(s)
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igth
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V Riprap length_
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ip
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Illdozing
Length�/— 60
not sure yes
um: n/a yes
yes
attached: , s no
i
ig permit may be required by:
Street Address/ State Road/ Lot #(s)
04 7 .eVV7- 1t1,r
Subdivision
City ZIP 7T 9
Phone # River Basin OrA.
Adj. Wtr. Body rr:��A% T,n�t tP (na
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(Scale: /'I/
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>cribe below the HABITAT disturbances for the application.
' sheet
values should
match the name,.and units. of measprement
found in. your
Habitat co .d e
TOTAL Sq. Ft.
FINAL Sq, Ft. .
TOTAL Feet
for.
FINAL Feet
(Anticipated final
(Applied for.
Disturbance.total
(Anticipated final
disturbance.
(Applied
Disturbance
distu(bance.
*at Name
DISTURB TYPE
Choose One
' inciddes any
anticipated
Excludes any
restoration
total includes .
any anticipated
Excludes any
restoration and/oi
restoration or
and/ortemp
restoration or
temp irti acts)
temp impact
amount
temp im acts
Impact amount
Dredge ❑ Fill ❑ Both [I •Other
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Dredge ❑
Fill ❑ '
Both. ❑
Other 13
Dredge []
Fill ❑.:
Both .❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other [❑
Dredge ❑
Fill ❑.
Both ❑
Other ❑
Dredge. ❑.
Fill ❑ :
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑•
Other E7

Payment Proccessing Confirmation
Date Received 12/21/2016
Check From (Name) Todd A Fontanini
Ronica Ann Fontanini
Name of Permit Holder Todd Fontanini
Vendor Yadkin Bank
Check Number 1538
Check amount $200.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 67985D
Receipt or Refund/Reallocated 1D/3425D

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner
Janet Frida
Address of Property: 109 Trout Ave, Topsail Beach, NC 28445
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Agent's email:
wa-rcE U-0,-
Mailing Address: 118 Gotschal Rd.
Danville, PA 17821
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 with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. 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 a pier, dock, mooring pilings, 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 Property Owner Information)
/1�/ --
Signature
Janet Friday
Print or Type Name
Todd. Fontanini
Print or Type Name

win
0 70162070000010943093
Add Name
Delivered:
KERNERSVILLE, NC 27284 on
December 1, 2016 at 3:27 pm
Updated Delivery Day:
Thursday, December 1, 2016
,dditional Information
Ia.
our item was delivered to an individual at the address at 3:27 pm on December 1, 2016 in KERNERSVILLE,
C 27284.
iet Text Updates
iet Email Updates
racking History
lecember 1, 2016
:27 pm
elivered, Left with Individual,
ERNERSVILLE, NC 27284
lecember 1, 2016
:41 am
lut for Delivery,
ERNERSVILLE, NC 27284
lecember 1, 2016
:31 am
orting Complete,

ecember 1, 2016
26 am
eparted USPS Facility,
REENSBORO, NC 27498
ecember 1, 2016
53 am
rived at USPS Facility,
REENSBORO, NC 27498
ovember 30, 2016
1:35 pm
eparted USPS Facility,
REENSBORO, NC 27495
ovember 30, 2016
55 pm
rived at USPS Facility,
REENSBORO, NC 27495
ovember 30, 2016
28 am
'rived at USPS Facility,
REENSBORO, NC 27498
ovember 30, 2016
55 am
E)parted USPS Facility,
ALEIGH, NC 27676
ovember 29, 2016
33 pm
rived at USPS Facility,
%LEIGH, NC 27676
ovember 29, 2016
43 pm

70162070000010943093
70162070000010943093
Delivered:
KERNERSVILLE, NC 27284 on
December 1, 2016 at 3:27 pm
Updated Delivery Day:
Thursday, December 1, 2016

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