54539D - Sasser

_ CAMA / ❑DREDGE &FILL 54
GENERAL PERMIT Previouspermit#!sd
-iNew ,-Modification �7Complete Reissue El Partial Reissue Date previous permit issued 11 If
rized by the State of North Carolina, Department of Environment and Natural Resources L ,
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC T • �xt ob
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t Name 1�111\1�jJ�t��f'1� Project Location: County
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�r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., S,
Authorized Agent Consent Agreement
n-yj w1 ny?I �o,.�a; : ;r ; ti r t 1 is hereby authorized to act on my beh
(Printed Name o(Agent)
der to obtain any CAMA permit(s) required for the property listed below. The authorization is limited tc
ific activities described in the attached sketch.
ATION OF PROJECT:
-7:�!3'-1G,o
PERTY OWNER MAILING ADDRESS:
IORIZED AGENT MAILING ADDRESS:
PHONE NO. Q\q - O3!i - I p4x:y '
PHONE NO. q %Q -'aa7 - 3`17s

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMIOORING PILINGSBOATLIFTBOATHOI/SE)
I hereby certify that I own property adjacent tois
(Name of Property Owner)
property located at 3SS P►Ct7)-& "A ,
(Lot, Block, Road, etc.)
on C14ra2x-;Fz1,-1- cntai-r ( , in -SfAC- g i= J ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 4tg - 73 -10 Mailing Address: a S Rn
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.)
K A41' 11 do not wish to waive
k 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)
a?s ; I r Sl %r-
Mailing Address
(Riparian Property Owner Information)
Signature
�orin� e � • 1 h onus i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to N`; ��,_ Q 's
(Name of Property Owner)
property located at 3Qci I Win, ,� Ll-\ ,
(Lot, Block, Road, etc.)
on e-12��X , in F:i=sg�`2 ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 43, 1!� - 734- i a4 Mailing Address: a*�st� Le, �F2C>
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.)
I do not wish to waive
V----------------------------------------------------------------------------------------------------
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)
3L 3 -t; i r SitE zn
Mailing Address
(Riparian Property Owner Information)
f
Signature
I A A

NC Division of Coastal N19t. Habitat Impact Computer Sheet
Applicant:�&Nv�'SOUWK Permit #: 5 4 S3a1
Date:
5/201p I'U "kMl
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat 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 fi
disturbance.
Excludes any
restoration an
temp impact
amount
O
Dredge ❑ Fill ❑ Both ❑ Other
I�
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]
5W3gD (vn)
BankofAmerica.
ACH R/r 053000196 'I
66-19-530
M. i
8406
C
0
$ cs�co ct"
DOLLARS a
8
— � /Il �'
AUTH IZED SIG TORE I
1110013406111 i:O 5 3000 196l: 0006 50 5 2 1990i,'