54481D - Chambers

9CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT
04ew ❑Madification ❑Complete Reissue El 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 N a co
[Rules attached.
t Name � A I v S Project Location: County �,)�151OUf
aL% A di r► LA VLF.
)VUlAGiS r-?VY StateNcZIP 2� (p0
:ed Agent /-f 41 ki I Com+yyc h m y o 1 t t(Af t
❑ CW XW IN PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes / \no PNA es / no Crit.Hab. yes / no
' Project/ Activity
ck) length tD X
�(s)�
ier(s)--4
ngth
tuber
J/ Ripmp
distance
x distant
cannel
>ic yards
ip
se/ Boatl
Aldozing
Length
not st
iu
not st
m:
lttached:
Street Address/ State Road/ Lot #(s) �3A,0,4_k
Subdivision
ity Glt1ZIP `�yltR
Phone # (`� Iu) 3811 - �37 KRiver Basin W l:�
Adj. Wtr. Body �V 1 WA 1// lnac ' nab
Closest Maj. Wtr. Body C[ IWU)
(Scale:
i
ig permit may be required by: AS OLD Ur � ❑ See note on back regarding River Basin rL
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Sc;ayj, is
(Name of Property Owner)
property located at 4j.,4 L>J ,
(Lot, Block, Road, etc.)
on F61 p+k�a Clt;r,;r L in -15 F4D_S irt�,2`� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: Q4 MA2.; )Pj I xJ
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.)
�C I do not wish to waive
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)
Mailing Address
Signature

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
el F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr., Sec
ah-r,"4Lti a re)hEMQCn is hereby authorized to act on my beha
(Printed Name of Agent)
�r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to I
is activities described in the attached sketch.
►TION OF PROJECT:
:'ERTY OWNER MAILING ADDRESS:
4 'vt N Lam►
ago tAU PHONE NO. c\\0 - 3.A
-IORIZED AGENT MAILING ADDRESS:
a If Ca0
PHONE NO. a\ \Q -- "331 7 - 3Lt 7
,1,

M Division of Coastal ?Agt, Habitat impact Computer Sheet
applicant: Permit #:
)ate:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
ound in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fine
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
iabitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
C1W
Dredge ❑ Fill ❑ Both ❑ Other A'
1 q Z
119,
0 W
Dredge ❑ Fill ❑ Both ❑ Other ❑
3Ub
Dredge ❑ Fill Both ❑ Other ❑
Z
■ Complete items 1, 2, and 3. Also complete,
item 4 If Ip trigted�Delivery is desired.
■ Print yo athd &I& address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
�yAo? "kLl—
�aa can AIM N
A. Signatur
❑ Agent
❑ Addressee
B. Received by (Pryit�d Name) C. Date of Delivery
-�11 fLt/ / S -2t-) D
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
XCertified Mail ❑ Express Mail
❑ Registered ❑ Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Deliver? Pdra Fee) ❑ Yes
2. Article Number 7009 1410 0001 5730 6741
(Transfer from service lateen
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dre ■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
Dre so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
A. igna
- 4.r' .f. i R �❑t
Address,
B. Received by (Printed Name) C. Date of Delivery
2 6 - Iv
D. Is delivery address different from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
1. Article Addressed to:

nm I
BankofAmerica. 8461
ANTINORI CONSTRUCTION
145 VIRGINIA LANE ACH R/T 053000196
SNEADS FERRY, NC 28460
[phone] 66-19-530
r�fr�r%L� n
c
IE _ H
F: $ ...ZIo, chi �
DOLLARS r
B
SIGNATURE
II5001B46 lll' 1:0 S 3000 196E 0006 SO S 2 1990n'