50278D - Lee

AMA / ❑ DREDGE & FILL �� 0 4
O
KNERAL 'PERMIT Previous permit# N//4
❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
thorized by the State of North Carolina, Department of Environment and Natural Resources
ie Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
:ant Name IAW A'1 NE- Ltt
ns
Statd ZIPS
S�ax#( )
rrized Agent
—1
:ed ❑ Cw ❑EW j� PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
�) ❑ PWS: ❑ FQ
yese PNA . " j-es,/ no Crit.Hab. yes / no
of Project/ Activity /�yj'jn C,1'-VCr- /,7.0,f `C 1, f
(dock) length x 22-
orm(s)
ar pier(s)
n length
number
lead/ Riprap length_
avg distance offshore_
max distance offshore
i, channel
cubic yards
ramp
ho Boatlift
h Bulldozing
!r
aline Length &e
not sure yes
bags: not sure yes
torium: n/a yes
X: yes
er Attached: yes
ilding permit may be r
Project Location: County
Street Address/ State Road/ Lot #(s)
I R S7.
Subdivision
City v� ✓` ZIP
Phone #q1O ) � � *t er Basin
Adj. Wtr. Body %M P -<eyAJO 6
Closest Maj. Wtr. Body STD 0 V A)
r4 7 1- le -
(Scale: ,

C Division of Coagtal Mgt. Habitat impact Computer Sheet
plicant:
>scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance.
abitat Name Choose One includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration an d/o
temp impact
amount
Dredge ❑
Fill ❑ Both ❑ Other
0
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 ❑

Nc Division of Coastal Mgt, Habitat Impact Computer Sheet
Applicant: iJ LEE
Date: 3 131 I2-0 (o
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet. TAL F t FINAL Feet
Habitat Name
ow
DISTURB TYPE
Choose One
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 ❑
Dredge 0 Fill 0 Both ❑ Other ❑
TOTAL Sq. Ft.
for.
FINAL Sq. Ft.
(Anticipated final
TO lied for
(App
(Anticipated fins
(Applied
Disturbance total
disturbance.
Disturbance
disturbance.
Excludes any
includes any
Excludes any
total includes
any anticipated
restoration and,
anticipated
restoration
and/or temp
restoration or
temp impact
restoration or
temp impacts
impact amount)
temp impacts)
amount)

r a y-- i s i 3 -y r 3
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UL'4h%?uE \-V
1055 ts,
S v2.r CND

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ael F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr.. Se
fis hereby authorized to act on my beh,
(Printed Name of Agent)
er to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to
`ic activities described in the attached sketch.
kTION OF PROJECT:
S
'ERTY OWNER MAILING ADDRESS:
7 Y PHONE NO. q test c,e, 11, cl a(., 1,
ORIZED AGENT MAILING ADDRESS:
PHONE NO. q/O - 3,A? - 3 Y 75

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to pt4)69)4r ►_EE is
(Name of Property Owner)
property located at 105'. Z, 1 s 1 sT ,
(Lot, Block, Road, etc.)
on MF)Q MRDt CPdJAL (MNIC) , in :!;OPr= c-1 i y , N.C.
(Waterbody) (Town and/or County)
Applicant's phone#: Mailing Address: Soo /.3ERSC-'? AQ
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.)
X I do not wish to waive
AW 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)
Sao 13 e5LY ko Y,
Mailing Address Signature

BankofAmerica.
ANTINORI CONSTRUCTION
145 VIRGINIA LANE ACHR?0530001go
SNEADS FERRY, NC 28460 66-19 530
[phone]
PAY TO THE
ORDER OF: hJ . i i� i - !�/ cc,
G.P t>oagrl wnJ >
MEMO 050arl�
AUTHORIZ SIGMA RE
11600826411' i:053000L96': 00065052199011'