54536D - Carlton

XCAMA / DREDGE & FILL 5
GENERAL PERMIT Previous permit#
D' New `:Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
iorized 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.
tnt Name bu (Q 5 �Vftil ✓ �i� �vn Project Location: County Oyyslcw
StateNL ZIP ;M 5
❑ CW IXEW PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes (no PNA yes / no Crit.Hab. yes / no
Df Project/ Activity
lock) length
'm(s)
pier(s)
length
camber
:ad/ Riprap length
ivg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
ine Length
not sure yes no
tgs: not sure yes o
>rium: / n/a� yes no
11I
E)(
-40
1 Attached: no
Street Address/ State Road/ Lot #(s)
^I
Subdivision '
/C�ity:�V►'� ZIP
P /1
Wr# ) 1S 0 - �4g River Basin �GQ
Adj. Wtr. Body l nat
Closest Maj. Wtr. Body n
(Scale: I i/_
Jing permit maybe required 1by: ^�(ifU. I 1 ❑ Sete noteonback regarding River Basin
i n_---_.^---'- --- /�Ij! 1� f711f\ f1 �,.A n�� P.� i r�'fi r !1#-n I0 n�M In.l —I . n. 11 - L- — .

A�_�W
A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
:hael F. Easley, Governor Charles S. Jones, Director Williarr. G. Ross Jr
Authorized Agent Consent Agreement
L-1 Nr� uo2� Cy�f is hereby authorized to act on my bel
(Printed Name o/Agent) gent)
-der to obtain any CAMA permit(s) required for the property listed below. The authorization is limited ti
;ific activities described in the attached sketch.
:ATION OF PROJECT:
►PERTY OWNER MAILING ADDRESS:
Ik_ L42`,'h.%C2r-jj L-J
vt9 '3 PHONE NO.
HORIZED AGENT MAILING ADDRESS:
3t8'q&C>
PHONE NO. - 9 1C - 3A7-- _I -A 7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent Cn ZL7i-,rls
(Name of Property Owner)
property located at C)i V 13ROADLZF1b
(Lot, Block, Road, etc.)
on S I om P SoJ,v U CANRC , in 6%2k-v- C/7-L? , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 9 1 D-` 91) //5a Mailing Address: f 11 %,J Y-gblCe-,OSi W
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 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.)
tsi
X I do not wish to waive
-11
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
•---------------------------------------------------
(Riparian Property Owner Information)
111 L4) `kart c1Zs✓t;—J L►.1
Mailing Address
/� ( J / Signature

f
i
_I
�I
_
I

Division of Coastal F49t. Habitat Impact Computer Sheet
Dlicant: Ce �Thum�eV,l�l-�vn Permit #: 5453(o C
le: S/ 1 4-1)
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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 Tina
disturbance.
Excludes any
restoration andh
temp impact
amount)
X.JV
Dredge ❑ Fill ❑ Both ❑ Other
2
Z88
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 ❑

ANTINORI CONSTRUCTION
145 VIRGINIA LANE
SNEADS FERRY, NC 28460
[phone]
PAY TO THE
ORDER OF:
MEMO � 5 1 53to D (o (+ . )
BankofAmerica .��
ACH R/T 053000196
66-19-530
AUTHORIZED GNATURE!
li°008 38611' i:O 5 3000 196': 0006 50 5 2 1990iI'