56630D - Carpenter

CAMA / --'DREDGE & FILL
1EN ERAL PERMIT Previous permit #
New I- Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
by the State of North Carolina, Department of Environment and Natural Resources
it Resources Commission in an area of environmental concern pursuant to 15A NCAC DD
rkT Rules attached
it Name
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U A J S State t ZIP
t O) t6 441 Fax # (.-- )
:ed Agent IL �) nM, LC�-S4,V1 11. \�
❑ CW FAEW APTA
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
yes(/ no) PNA yes
i
l,f Project/ Activity
ock)lennth
❑ ES ❑ PTS
❑ USA ❑ N/A
Crit.Hab. yes `'no
Project Location: County 6 " G W
Street Address/ State Road/ Lot #(s)
Itu 15c(i iJcirr4 ktaiL
Subdivi`�ion IN A
City YnA, ZIP 2H(o
Phone # ( River Basin
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ling permit may be required by: u,Stwj L , ❑ See note on back regarding River Basin i
,�---!-. -ILL 11o) A.,, nil ,U._I .,.,_..l_L. _ .,. , R..II, I--

31-2011 10:03 FROM: TO:1'31003c70135
i 27 10 04z44p P•2
r4a;Nor, Lw i Fi4'Yb 7/0 - 3 7-7- ©! 3.S
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PLER/MOORING PHJNG"OATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 11IdAy)aI . , Ca t�f'iYi+rm 's
QQ(Name of Property er)
property located at —_ 10 U U 1 ly 1 ,I +- �-c I
(Lot, Block, Road, etc.)
on 'a 'A SUSi, Ce ` G , in S Gl S CJ N.C,
(Waterbody) (Town andAdr ounty)
Applicant's phone##: t-&vl Mailing Address: a2f% kQ
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlif3 / boathouse
must be set back a minimum distance of fifteen feet (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.)
<r~� I do not wish to waive
114 wish to waive that setback requirement_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by btdividual proposing development)
(Information for Property Owner Applying L(Riparian Property Owner Information)
for Permit) (��
SWon
Mailing Address
Signature
S*V ads
I'1(G c) aeU ��%ov�t `Jr.
City/StaUeJZip Print or Type Name
t,L._9 L)-(.(,rtl
Telepil oue �%"'It %) /7
Telephone Number

.—..- - - -- - - - P. 1
?? 10 04:35P
ADJACENT RIPARIAN PROPERTY OWNER STATEJ[ENT
(FOR A ,prEit/MOUX WG PLUVGS/BOATUIPT/BOATE'O USE)
I hereby certify that I own property adjacent to r1VAIP ] _,tea K :.LUA s
(game of PropertyOwner)
property located at IOU ` -C 1 1 ' "i 6 T I
(Lot, Block, Road, etc.)
on L57- in
(Waterbody) (Torun and rComity)
Applicant's phone #: 9 10 — y 2 - (A- 1 Mailing Address:-.t s �-
5 )JEgDS
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fiRcen feet (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 -not wish to waive
I do wish to waive that setback tequirement.
DESC UTUQN AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be, filled 1h by individual preposixg development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
&AJ
Mailing Address /Signature
�A'At Ctds E" NC (? h /6 tl?eaj-4f
City/State/Zip Print or�rTy�/pe Name
Teleply Number /' Telephone Numller

AM
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
;l F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr., Seci
is hereby authorized to act on my behal
(Printed Name of Agent)
�r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to t
c activities described in the attached sketch.
TION OF PROJECT:
S iyaas 4EV
'ERTY OWNER MAILING ADDRESS:
22� 5 way PGtVLt Pj
`��NCdS �� W- 264(t0 PHONE NO. q10-y(-?` L-,C-4)
ORIZED AGENT MAILING ADDRESS:
ri o0ln5%YUcfi0✓1
dada Nz at�9tn�
PHONE NO. q-ttt,-3:X?- 3tii�

LJ
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.... ......

Division of Coastal Mgt. Habitat Impact Computer Sheet
)Ircant:'A`,J ,� Permit #: r
le:
21-Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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)
J
Dredge ❑ FiIIXBoth ❑ Other ❑
5
Dredge ❑ FillKl Both ❑ Other ❑
��
2
Dredge ❑ Fill ❑ Both ❑ Other
�3 O
123 (7
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 ❑
(: = Cll

ANTINORI CONSTRUCTION
145 VIRGINIA LANE
SNEA�98460
10) 327-3475
&azqn��Pyyl--)
/Ulu' &u4j,", 5
Bankof America.
ACH R%r 05MM196
66-19-530
�11TIIR�17141GNA E
Jim 008193911' �:OS3000 196l: 0006505 2 199011'
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