50312D - Bundage

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
]New . Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
3rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
it Name Project Location: County
Street Address/ State Road/ Lot #(s)
State ZIP
#(_ ) - Fax#� )
ized Agent
-
d -
CW ❑ EW ElPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes 0
PNA y&s , nc Crit.Hab. yes / no
of Project/ Activity
;dock) length
r pier(s)
ilength
number
lead/ Riprap lengtl•
avg distance offshor
max distance offshore -2
,channel
cubic yards_
ramp
louse/ Boatlift
i Bulldozing
r
Subdivision
City
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body
:line Length
notsure yes no
lags: not sure yes no
r
Corium: n/a yes no
is: yes no
:r Attached: yes no
Iding permit may be required by:
s/ SnPrial Conditions
ZIP
River Basin
(Scaler' "
❑ See note on back regarding River Basir

oAkl
r

ram'*
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. ,ones, Director NdGatr G Ross r . SecrHery
Authorized Agent Consent Agreement
cia �.crD. ;,,.--,,,,,� is hereby authorized to act on my behalf
(PrWad Nears of AWr)
in order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
specific activities described in the attached sketch.
LOCATION OF PROJECT:
PROPERTY OWNER MAILING ADDRESS:
1s 5 PHONE NO. r' •� -3St`i -/ i 5/G-
AUTHORIZED AGENT MAILING ADDRESS:
Signature of Property-U-Wner X
Signature of Authorized Agent

AWAiCWr RIPARW P' T �rrr
(POR A rJFJC4WWlUNG
1 batbY ratify dW I own VMpaty odjaead a'042M of
propaty O—) s
propamy Iocs" s1 frN7 _L-- ( Blaek, Road, ems)
on ! tintr)l crown apolar Ca "WO
(WeterWP1
s MaHioi Addsys:ll:iS.� �• ••.�+•� '--=—�'�
u dug l
He hadwribed tomc, as aboe+n betov+, du devdoPm�` he ts Wopp m t /oo, and. )
have no al jib ppi
to ids or—L i ,.nda.t+el dre. .rlw:o r66 �^s' i be.tiiRbnadsaiae
roust be $4 beds a niS14— dis noo of Ktlem Eta () 59 how my arw of � aoceia uwleaa
wa}vod by me. (4f you wmb So wm." tM mtl*: rm wow imikW dke NPR MWk
below.)
X, > Lga wish to Wawa
90—D;ZISCWMN
ANDIOIlMAWINGOltrRoeosBAo9 FKT:
(7, 8rrfamd ie by intsvid+d p►opainl &Mkpwpw
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Dim

,4WAC Or RITARIAN MOMRTY OWNER STATBMV"
(Poll A r/jt"WXIIVG YII-►tr ;&WATU"YAO)ATMVSA i
t hereby catib rhea t own wovMY edje—tt w (plate. of Property Owner)
a WwA6 RMd. dc.)
in ��e11ti-
oe _ (� ) Roma aadhr Cawe4)
iic he►deaafbad a otr. as dw beloer, dre deeelopwret he it proporiad at M batioq 1-k I
t eerderelrrd treat • P�✓*�M pdop / boeditt / bodrota.
Irv. ao a *,i,, to bit p ofo=G of fiRwt low f 1S) freer m7 ens e�"!��^ �ecns uabt
sin, We set bw* a w"Imm disaa c
..awed by roe -(it r- �Ieb a waive the telMdt. — t♦att am" the apr�r+ bhreh
below.)
X 1,a'm wish oD waive
tjawish IO waive tlul telbeCk re*ttrmrew.
DE#CN MON ANDOOM DRAWLVG OF FROPOSK"'WVLI.OrMLK[:
Ili ie flAW IN h' p1lmi/re//r+ K rlem&pe -O
(Ifienngm for rroreeh 0— A► **$
for
am"rtea reaper" Owew ►.kr..O..)
tulaiq A
� yy[�NY. r 4
prier er 1'laare
Tekf*KMC NUMD"
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EMS:
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Division of Coastal Mgt, habitat impact Computer Sheet
>licant C-7r
.e: 3 (Z3'7 0 la
for the application. All values should match the name, and units of measurement
scribe below the HABITAT disturbances
rnd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL FeetFba
for.d
et
final
(Applied for.
(Anticipated final
(Applied
DISTURB TYPE
Disturbance total
disturbance.
Excludes any
Disturbancee.
total includesanyanticipated
ibitat Name Choose One
includes any
restoration
any anticipated
and/or
restoration or
and/or temp
restoration orct
Dredge ❑ F, Both ❑ Other ❑
Dredge ❑
Fill
Both ❑ Other ❑ ` 1
Dredge ❑
rk
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 0
Fill ❑
Both ❑
Other ❑

�1M
ANTINORI CONSTRUCTION
145 VIRGINIA LANE
SNEADS FERRY, NC 28460
[phone]
Bank of America.
ACH R/T 053000196
66-19-530
PAY TO THE ` i �, n r $
ORDER OF: r /
DOLLAR
MEMO G P503'a (,fin • /
/,/✓�� i
AUTHORIZED GNATURE
119008 2 5 2ii' 1:0 5 3000 19 6i: 000 6 SOS 2 4990,10