61596D - Rodrigues

-ICAMA / ❑ DREDGE & FILL nn�
"ENERAL PERMIT M 6
,New ❑Modification ❑Complete Reissue 'Partial Reissue
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ' (Jt✓�
Rules attached.
t Name �r .Y� f } N 1�1 K G/ Z% F Project Location: County
T E N (OK' Street Address/ State Road/ Lot #(s)
QZA Z �- State PAAZIP 02-532 _ u0q kjNL-s Lq01 ie'
4 -79 -7k # ( ) Subdivision
-MNA:ed Agent _� y-Y h�Y1�7� 1Ckj`s j Yit tCity I� ZIP
C CW ❑ EW PPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH r� UBA ❑ N/A
❑ PWS: ❑ FC:
yes /,no PNA yes /,fjo Crit.Hab. yes / no
Phone # ( ) River Basin ����
Adj. Wtr. Body E� ( HAW NEZ— Oat
Closest Maj. Wtr. Body /h WAN
r Project/ Activity tZ t--i..y (/y` Ly i 5-ng, c /i ) Nl (,
F" (Scale:
C t o r 1a
ck) length frxT t- a..i ... . .. ,r
ier(s)
ngth
tuber
d/ Riprap length
distance offshore
ar distance offshore
cannel
tic yards
np iseto�a la i p
Z )1
ulldozing
e Length
not sure yes pOF6
s: not sure yes a n
ium: n/a yes n
yes II
Ittached: )
rig permit may be required by: _
�SLr�-iN�
❑ See note on back regarding River Basin ri
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AMERICAN MARINE CONSTRUCTION
PO Box 11046
Southport, North Carolina 28461
Email: AMC036000*o1_com
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Name or Individual Applying For Pemmir. Rr 1 QUA
Address of Praperry (r 6 (,4 i AC!s L R.
flot or Street #, Street at Rol
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:.City and County)
`. herebv certify lilac 1 own propery adjacent to the above- referenc ea propt^ti-. The individ%w
appl),ing for this permit has described to me as shown on the anacheo draw,cg me developmxnttixy
are pror.t?sin¢. A description or drawing, with dimensions, sholold be cnovidec! withthis ►eiier
000
I have no objections to this propesaI
ou have objections to what is being proposod, please write the Division of Cofisit
aLksuagement, III Cardinal Drive Extension, Wilmington, NC 18405 or call 910_796.721t
within 10 days of recaip.t of this notice. No response is considered the some as no obleaioni'
you hove been notified by Certified Mail
WAIVER SECTION"
1 uaderstand that a pier, dock, mooring pilings, bronkwater, Door house or boat (ittfnustbese
bcka minimt:tn distance of 15' from my area of riparian access - unless waived by me• (ifyo
wish to woive the sctback, you must initial the appropriate blank below t.
i Na me
{ do wish to waive the 15' se'back requiremont
l ti� wish to waive the 15'setba:h requiremcw-T
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AMERICAN MARINE CONSTRUCTION
PC) BOX 11046
Southport, North Carolina 28461
Email: AMC036000sol.com
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Name or Individual Applying For Penniz: �i uC5
Address of Progeny , , L, I/s L — r1
(Lot or Street is, Street or oad)
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C Co'K T5 eCUYIS�iLCR
'.City and County)
hereby certify that I own property adjacent to the above•referencea proptr-�, The iadividu
appl?'in9 for this permit has describcd to me as shown on the attachea dmw,r-g me deveWpnwattiv
are prorosin scription or drawing, with dimensions, snotuld ee t'rovided withtSk Liter
>— no objections to this proposal
s 111 you hsve objections to what is being proposed, please write the Division of Cout
Matagement, 127 Cardinal Driva Exten3ion, Wilmington, INC 18405 or call 910-796-71,
within 10 days of receipt of this notice. No response is considered the some as no ot1ection
you hove been norirted by Certified Mail.
WAIVER SECTION
! understand that a pier, dock, mooring pilings, breakwater, out house or boat ii4ttr►"t be
bcka minimum distance of 15, from my area of riparian access - unless waived by me. (ify
�0sb to lw3ive the setback, you must initial the appropriate bleak beiow
1 do wisp to waive the 15' setback rem%iremont
. requiremeror
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr
tY�
Authorized Agent Consent Agreement
is hereby authorized to act on my bi
I - (PrinteCIName of Agent)
order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited
iecific activities described in the attached sketch.
DCATION OF PROJECT:
(� t� Kinas L. j n+n car.
ROPERTY OWNER MAILING ADDRESS:
3✓ZZ/��5 �/��' a PHONE N0..s'Z)�'-
UTHORIZED AGENT MAILING ADDRESS:
rc�
PHONE NO. q (n r L-1 S 1- S qU
,ignature of Property Owner:

Pr
kpplicant:� Nllo��
)ate: 5 r7/ t�
Permit #: 6 Is %
lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
abitat Name DISTURB TYPE
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)
Y v 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AMERICAN MARINE CONSTRUCTION INC
CHARL S H. OR KAREN Z. PERRY
P.O. BOX 11046 910-457-5488
SOUTHPORT, NC 28461 DATE
PAY
TO THE
(ORDER OF� 1
DOLLAF
First Citizens
Bank
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