62532D - Phillips

CAMA / ''DREDGE & FILL
GENERAL PERMIT Previous permit# --"
lew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
T� s attached.
nt Name 6-k-� P14 1 Project Location: County
10- kAA 5 M'A Street Address/ State Road/ Lot #(s)
f✓61 / �..-- StateIP
0f�(L) Q S0&ax r#( ) Subdivision
zed Agent City v % ZIP �y
❑ CW ,ij�tW APTA XS El Phone # ( ) River Basin
OEA ❑ HHF ❑ (H BA ❑ N/A
Adj. Wtr. Body n
PWS: ❑ FC:
yes /,no PNA yes ' 6 Crit.Hab. yes /�fr Closest Maj. Wtr. Body
)f Project/ Activity i ? - �, �✓ 't�✓o ock r1
W. W-E Mod
ength 0
umber
�Ilfta;li���
ad/ Riprap length
■ ��!'%.
i
MOMiax distance offsl re
NENOrWEEN
W AEN
jbic yards ■■■ENE ■■ '1
■tea■■�!I
,use/ atlift
�■ail■�■■■r��
■■■ ■■
■NO ■: ■
PRIM
IG If
(Scale: I // =
. ❑ See note on back regarding River Basin

,pplicant: 5O 11 � � Permit #:
ate:
-scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
DISTURB TYPE
bltat Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance-
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
(� Dredge ❑ Fill ❑ Both ❑ Othe
z.
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NE LANIER ANTINORI 1005
.INE ANTINORI CLEANING 66-21/53010388
4 HARRIS CREEK RD _T 2681857492
ONVILLE, NC 28540 9484 DATE 1 I Z� 3
s Z-ClI'D, Oo
-✓` ! [ �L� �LL��I `� lL�� / Cl� DOLLARS e
e / ���z _etc/-
L00 Silo i:0 S 3000 2 L9i: 268 L S 74 211'

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12.! k 2L,' deck Y If k lb" GAZe-bn i
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MD-EWR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: U ► - 13
fame of Props rt Owner Applying for Permit: Name of Authorized Agent for this project:
-- Ta.,Sonr IJfir 11► ps R&d- 0Ai-n-DJi
wner's Mailing Address:
A9g30�0sonC�)2�
ya"L 4✓ AIT d g 3 g T
Agent's Mailing Address:
2'1`1 2e,s C2e�fc 1�d.
�a�sflu�ilie nt.e. �Qs�D
lone Numberj_gi(9 ) a J0-0 13 $ Phone Number AD ) 93D- 55Db
srtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
JZ'x Z(o' deck G-7/ 12. K 1b' IQZ-e�o over �QL]e-
Z LOp-t' 1 i tf5 Pack SAC
my Property located at y0(oq #k sate Gtj N.C.
s certification is valid thr (date) o)--21
�4, r- -
_
km
L� IT )3
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: _J OSDN k114,0S
Address of Property:
Agent's Name #
"C�
(Lot or Street #, Street or Road, City & County)
auoe l-
Agent's phone #: 60- 33D- .SSm
Mailing Address: 2—%4 �fi ffIS �
-sDJ)Vd11pe N. 0, 19 S40
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 vet e setback, you must initial the appropriate blank below.)
do wish to waive the 15 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
W ,� (,
Sign4iure nn
Print or Type Name
z-i'j
Mailina Address
(Adj cent Pro, arty Owner or tion)
3ignarure--
Print or Type Nan e
Mailinn 4r1r1rucc

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: =asbm PkdlIQ-s
Address of Property:
t ob-7 y +� st. su 1- Li
(Lot or Street #, Street or Road, City &
Agent's Name o. J&cl d ar'(LnO6
Agent's phone #: 11�' 33Q-SSC� t7
N
Mailing Address: '27�akkk CAA
.�aC��b�ly►11�. llJ.�. ��35
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.
V/— 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.)
bL,--I— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
I "W',
A—Z- F I J;"/)
Siglature TW
70SDn R;II►��—
Print or Type Name
2.11 71D%n Dn Ck.
Maiiinn !Mrlraec
(Adjacent Property Own *r Information)
Signature
lrze �h%u l•UD�y �l
Print or Type Name
yD h 9 'fy�- st.
AA�il;- AA,4-