57430D - Barnhill

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to -3—rAmr--S �t2 2iJ Ra l Is
(Name of Property Owner)
property located at t,10 Z�
1
Address, Lot, Block, Road, etc.)
on in Dhfs 10 W S(.� 2 t C..► �"� N.C.
(Waterbody) (Town and or County)
He has described to me as shown in the attached application and project drawing(s), the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
j 11 II
\E P1p [E CA d hLl Jk �Mj Signature
J
n1 E W U I N Y ( rV1 C..I • Print or Type Name
>r--P Acz- olJ lecJcin`1
w i t� NE w m a,-t-j-z ej j
Telephone Number
Number
(k+' - Zo(\
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to -s
f_ (Name of Property
/Owner) h `
property located at C 2
Address, Lot, Block, Road, etc.) ll
on WJJa� in C nj51 GI,J — iz C1TU N.C.
(Waterbody) (Town and/or County) I
He has described to me as shown in the attached application and project drawing(s), the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
ZEpicc�
OVA
Signatur
KoeRt9ctvtN per
Print or Type Name
?-S Z- 0 39 - Z� 5
Telephone Number
Date

licant: JS Pjl bb�j L�
-7'13-il
Permit #: 5--,� VI ; —D
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
tat 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)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill Both ❑ Other ❑
, 2—vo
r r
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 0 Both ❑ Other ❑

1'11J1 < 111GC11J
First -Citizens Bank & Trust Company
Raleigh, North Carolina
NCDENR
05594139
1
$200.00 �r
NOT GOOD OVER $1,000.00 - INVALID AFTER 180 DAYS
T, '1 Dollars
4
July 14, 2011
PATRICK ANTINORI ...Gf-)5'146c� �_ �1' _t -.,L
l Lim- � 47lJCJ CCC..,,
2/06) !
t303430 12 ;99MOCIC7
11005594 L39116 1:053 L003001:980799499011,
31
.fames E. Barnhill 1-82 ��516 3250
P. O. Box 1154 Ph 792-1437
Williamston, NC 27892 /-'
�// ��_�— IblTt
PAY TO f I IL
ORDER OE ? ___ — -- $ �
i
]y/ {/9 DOLLARS �
Look or: Micronature line, hand linewnrk. first Citizens Bank logo n 6ack. I' (not present do not cash.
First Citizens
,III rstcIt e s ico
_
1:053 1003001:005 L667 L98761 03 250