53162D - Butchington

:AMA / 1 DREDGE & FILL
E N E RAL PERMIT
Previous permit #
Jew ❑Modification CJComplete Reissue Partial Reissue Date previous permit issued
ed by the State of North Carolina, Department of Environment and
Natural Resources
astal Resources Commission in an area of environmental concern pursuant to I SA NCAC
ules attached.
Vame tP%'- 9'�
Project Location: County L,J�
01 \ �{Zia� 1 (Lit Lr.1
Street State fjpa�l/ Lot #(s)
�2 �'� L �- State ►� C, ZIP 2-�� 1
``A''ddress/
�y � G 1
71\)C\tci "-1L4 i Fax # ( )
Subdivision
i Agent N L �R L
/ ' 1
City �y` n-� L/r ZIP 2 -1
Ci cw xWA El ES ES PTS
Phone # ( ) River Basiry6
C OEA ❑ HHF '❑ IH ❑ UBA = N/A
,� J ))
Adj. Wtr. Bodl�r�n n jU�^.-�D `LA (nat
. PWS: ❑FC:
I -L `"
i
s /1` off PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
'roject/ Activity
ob 2 i-
(Scale:
)length
1
J
I
l
-
th
)er — -
Riprap length
listance offshore
distance offshore-
inel
yards _
Boatlift F Y t7
dozing
Length Sr
not sure yes
not sure yes ��
m: n/a yes
yes o
[ached: yes no --- /
permit may be required by:
❑ See note on back regarding River Basin rule

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3r 11 08 03:09p
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOOREVG PILIIVGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 3UZH 1 r,C i C ►.I _'s
(Name of Property Owner)
property located at _ (1-c:• j ] L--: i N `7
(Lot, Block, Road, etc.)
p.2
on -'V-C �..; L , in kY s tT N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ca Iq - 5 -:� rr- 291 Mailing Address: �ZCI I I CKa37-R,E "
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
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)
Mailing Address
(Riparian Pro Owner Information)
i
.�'ionahrrw

r 11 08 03:09p
p.2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that 1 own property adjacent to %,5 b1mA �—To 's
(Name of Property Owner)
property located at (oc q 7 (� T rt - S
(Lot, Block, Road, etc.)
on i Cam✓►,., , in S :.:Z— c r-- , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ci %9 - ci A.9 -7ti/ I Mailing Address: A01 / C 246TA� i
He has described to me, as shown below, the development he is proposing at that location, and,1
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.)
46 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)
e'zz��
Mailing Address
Signature
�. / y

r 11 08 02:48p
p.2
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley. Governor Charles S. Jones, Director Klliaar G. Ross Jr., Secretar,
Authorized Agent Consent Agreement
Rri"ri hc. e-%R i CrI ohj is hereby authorized to act on my behalf
(Printed Name of Agent)
order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
)ecific activities described in the attached sketch.
DCATION OF PROJECT:
ZOPERTY OWNER MAILING ADDRESS:
ITHORIZED AGENT MAILING ADDRESS:
/ �S" V I ,r2loinli A 1.ti!
- Cyr
PHONE NO._ �'i�C/ • rja�j-7y/ 7
PHONE NO. >/Q -3a7•-
mature of Property Owner
nature of Authorized Agent:

IN
ANTINORI CONSTRUCTION
145 VIRGINIA LANE
SNEADS FERRY, NC 28460
[phone]
<�ky
0
N
C. D >_ n/ . A? $ aC*' 1-1 9
aanKorwmenca�i
ACH R/T 053000196
66.19-530
11600752211' i:0530001961: 000650521990118
AUTHORIZED GNATUR
0
DOLLARS
rl
In

■ 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:
EW34-1)N
5aa3 141 Ccc N RD
MCcLEA►451r I LLIP, NC
a')3c1
A. Si ature
X ❑ Agent
❑ Addressee
B. Received by ( Printed Name) Date of D livery
3(f9, ,1,
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label) 7008 0150 0000 5544 7091
PS Form 3811, February 2004 Domestic Return Receipt
■ 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:
'A i) l.cN6N J12
102595-02-M-1540
A S �n ure
Agent
X� ❑❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1?/ ❑ Yes
If YES, enter delivery address below: ❑ No
C1 �� 3. Service Type
v'1a ?Sac Certified Mail ❑ Express Mail
9 Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 71108 01,50 0000 5544 7084
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540