55847D - Lee

.i CAMA / :-1 DREDGE & FILL
3ENERAL PERMIT Previous permit# .55
New �]Modificatjon ❑Complete Reissue ❑Partial Reissue 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 I SA NCAC
Rules adached.
t Name Wh L Project Location: County
i Street Address/ State Road/ tLot' #(s)
' Q Statet4c ZIPQ(3 , b
( Fax # () Subdivision
blc) SF �� ►�
ed Agent &AA&I Ui.4M City + ZIP aLALA
❑ CW YEW X PTA �ES ❑ PTS Phone # l f IC )3 River Basin
OEA ❑ HHF ❑ IH UBA ❑ N/A - --11 R �—
- PWS: ❑FC:
yes /11 no PNA yes /tno:
Project/ Activity
-k)length
Adl. Mr. Body Qk A1!5 (nat (r
Crit.Hab. yes / no
Closest Maj. Wtr. Body A I W W
(Scale: I //,
ig permit may be required by:
by: T' w j , (T(L ❑ See note on back regarding River Basin ru
Special Conditions '1 111n . � l a' h a lAd all Il f1 1/ I C, /j 1 <6 k t11AA LI A I A I v-/ f J t1

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
fAichaei F Easley, Governor Charles S. Jones, Director Will air, G Ross Jr- Secretary
Authorized Agent Consent Agreement
AtJTt>adP cam. —i'^'A is hereby authorized to act on my behalf
(Printed Name of Agtn.)
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:
ci MC
PROPERTY OWNER MAILING ADDRESS:
X39d f9rrn 9�"d -
1 Nc- =�1(o 03 PHONE NO 1 -`6 -7S7,
AUTHORIZED AGENT MAJUNG ADDRESS:
PHONE NO
-, n

Rug 23, os a6:07p
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PIMNGSBOATLIPTIBOAMOUSE)
I hereby certify that I own property adjacent to tZk XUR B -X I Is
(Name of Property Owner)
property located at % L � ST
(Lot, Block, Road, etc.)
p.l
on ;_�_twny: r Lm,,� , is i Was; c , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
MalUng Address:
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 (151 from my area of riparian access unless
waived by me. (If you wish to wane the setback, you must initial the appropriate bleak
�I� below.)
%4N I do Dot wish to waive
7� I do wish to waive that setback requirement.
DFSCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled In by Individual proposing development)
(Information for Property Owner Applying
for Permit)
a
g Address
1�_ � . !a
-iil"
(Riparian P.vperty Owner Information)
�ature
X 013)L P,EX-
Print or Tvne Name

4C Division of Coastal Mgt, Habitat impact Computer Shut
\pplicant: III VA101 V—V LJ��
Date:
r the application. All values should match the name, and units of measurement
Describe below the HABITAT disturbances fo
found in your Habitat code sheet. F TOTAL Feet FINAL Feet
I DISTURB TYPE
Habitat Name Choose One
Uw I Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑
Fill Both ❑
Other ❑
�- Dredge ❑
Fill Both ❑
Other ❑
Dredge ❑
Fill ❑ Both ❑
Other ❑
d e
Fill ❑ Both ❑
Other ❑
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and 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:
'ae�R>� M`�a+aA�
l07 �A� sT
N C
as3')5
2. Article Number
(transfer from service label)
PS Form 3811, February 2004
TOTAL Sq. Ft.
for.
FINAL Sq. t•
(Anticipated final
(Applied for.
(Anticipated fina
(Applied
Disturbance total
disturbance.
Disturbance
total includes
disturbance.
Excludes any
includes any
Excludes any
any anticipated
temp
anticipated
restoration
and/or temp
restoration or
impactnd/
temp p
restoration or
temp impacts
impact amount
temp impacts
amount)
1 I y
A. Sign Iture j=
❑ Agent
❑ Addressee
B. by flame) C. D%of Delivery
D.`Id deliv6ryXdress drfferent from item 1? ❑ Yes
If YES, ter delivery address below: ❑ No
3. Service Type
JK Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 0960 0000 6030 9566
Domestic Retum Receipt
102595-02-M-1540

ANTINORI CONSTRUCTION
145 VIRGINIA LANE
SNEADS FERRY, NC 28460
(910) 3273475
Bank of America��
ACH R/f 053=198 '
66-19-530
PAY TO THE �Q, $ 6coI a
ORDER OF: C ' CX
MEMOq P 5✓ U 1--b ��)
11'00866 111' 1:053000 L96i: 0006505 2 L99011'
AU7HORIZ SIGNATUR