55811D - Gallaher

CAMA / DREDGE & FILLT
IENERAL PERMIT Previous permit # '
f New -Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North.CarolinaVDepartment of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC TIS&RD
�}
ules attached.
tName PA ofilnke{,
! C Sk-U State( _ ZIP 2��
(�) 3a-+ - J(,5L Fax # ( )
ed Agent yl{�►1tYl r1S� . /� ( I u U -�v
CW 'NEW >�PTA ❑ ES ❑ PTS
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑ FC:
yes no PNA yes no Crit.Hab. yes / no
Project/ Activity
Project Location: County C OS I b W
Street Address/ State Road/ Lot #(s)
Subdivisionydliuw r-lkt+
fcity 5elwu ZIP �01-kk
Phone # ( It ) MF 8379 River Basin(
Adj. Wtr. Body i Ur1c� fnat
Closest Maj. Wtr. Body 1A
I (Scale:
:k)length _ 1
er(s)
igth
nber
I/ Riprap length
distance offshore
x distance offshore
annel
Pic yards
Pp
se/ Boatlift
Aldozing
�IP�►� W/�U.
Length /
not sure yes FL.
not su yes
um: n/a yes
yes
attached: ves no
ig permit maybe required by: [)V On3W
Special Conditions -4k - A (t-b a
14 U ❑ See note on back regarding River Basin ru
of (A-LvlrM -,�-l-a-�r_ (-k1AA LAC"i 1/-(11%I12+I"KK a

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to E'p GgLRUgE59 is
(Name of Property Owner)
property located at )WJ 3/6 /jAIniyyn< 421n1T AD ,
(Lot, Block, Road, etc.)
on ? C• l,,%. , in SN,�A03 ? , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: QID-3X2-a4 Mailing Address: J*Y l4, MaMA2 rr )OMiv
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.)
�KT
�K I do not ' h to waive
i
X 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 (Riparian Property Owner Information)
for Permit)
Mailing Address
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to t± D r.Alt A l l;*, is
(Name of Property Owner)
property located at 144 4 tmt, kA AMmcc�e_W)i m T litb ,
(Lot, Block, Road, etc.)
on 'T in �NF71D� Fjr=1ZlZ� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ct1D -3a7-2LQ Mailing Address: /Ny 81& NAmtrDce A6v7- 1
bl.IFADS rpPr ,?_ wr axim
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.)
107, I do not wish to waive
14
I do wish to waive that setback requirement. A4-
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
11Y /3 /6 }i19MirlcxlC ,2U
Mailing Address
(Ripari n Property Owner Information)
�ELIC
ocK
scot
Signature

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr., Sf
AN, —INS l�l r'nA157eLY71&jJ is hereby authorized to act on my beh
(Printed Name of Agent)
der to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to
ific activities described in the attached sketch.
ATION OF PROJECT:
Po)nr, 14Q5
_;Z9Ll64f
PERTY OWNER MAILING ADDRESS:
' ZRaVG6 PHONE NO.
HORIZED AGENT MAILING ADDRESS:
X
PHONE NO.
,' /,'

i f I I
I I
I I I I i I
:

C Division of Coastal hf1gt. Habitat Impact Computer Sheet
plicant: 0" 0'. kLK Permit #: J
ate: Q�2
7i lip
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat 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/oi
temp impact
amount)
S
Dredge ❑ Fill ABoth ❑ 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

I
8564
Bank ofAmerica.
ANTINORI CONSTRUCTION
ACH R/T 053000198
145 VIRGINIA LANE
SNEADS FERRY, NC 28460
[phone]
Ae-
66-19-530
DOLLARS
'�55�61aDcan�
lip 558I) D Cad
111-171,
Oz� LIZ.&
AUTHORIZED SICNATURE
II■00B56t,II' i:053000 L96i: 0006505 2 L99011'
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