53954D - Williams

LAMA/ ❑DREDGE & FILL 5 il
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iENERAL PERMIT Previous permit#
New Modification IIComplete Reissue IIPartial Reissue Date previous permit issued
zed by the State of North Carolina,Department of Environment and Natural Resources . 1
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
Rules attached.
Name tP-+- v✓SI LTA,r^ ' Project Location: County ©N)51--...----/
)' '' y1('\ ¢ZNt)' .Ikl..) VV,A-) Street Address/State Road/Lot#(s)
L.fAD S cc- L i-`i State-4- ZIP Z., `'j P Sr
( ) Fax#( ) Subdivision
:d Agent City tJt:ALN.S (-i?L2 ZIP Gt-'-A to i
❑CW [ W 'PTA ❑ES ❑PTS Phone# ( ) River Basin Vi•lx1'E
❑oEA ❑HHF ❑Ill ❑UBA N/A Adj.Wtr. Body(1-)1)(LL L S G(?_ t L na /n
❑PWS: ❑FC:
yes PNA / no Crit.Hab. yes / no
Closest Maj.Wtr. Body I%`^, ZJ ie=-'--
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(Scale: 1\57'
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(s)
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ng permit may be required by: Or51- '`^J l/'A�,--rs-`� • I I See note on back regarding River Basin n
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4S77,„A
•
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
:I F. Easley, Governor Charles S.Jones, Director William G. Ross Jr., Seci
Authorized Agent Consent Agreement
NTINoP_! Co_N15TR ipn/ is hereby authorized to act on my beha
(Printed Name of Agent)
tr to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to t
c activities described in the attached sketch.
TION OF PROJECT:
>3 I in D1 up.N1/41-)
L(tLtS h=i� J t� .
'ERTY OWNER MAILING ADDRESS:
6-6 NC I- Y 93
v -S PJ .) N(,5 r ag,52 s �- 5a - a.c 33
PHONE NO. 'o
IORIZED AGENT MAILING ADDRESS:
;A- '3 V)126, J/i kAI.
') E-"H 3 j—f=n C. .
PHONE NO. q1 Q - 3a7-3973
,fl _ w �l I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to $lu \ f 's
(Name of Property Owner)
property located at '►033 rn r 211J1 Ay.S �J '
(Lot, Block, Road, etc.)
on CA-4(4'Zti S CJ2cFs( , in FA-Eys ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 2,5;I-5. 3 "0t3%Mailing Address: r03'y rn 0 la J
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 I.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.)
vriC
f I do not wish to waive
""J • Ai I do wish to waive that setback requirement.
I , 0 c) 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)
055 (n FRi o\ <4 '.3 y ?
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 1.Dv uagiA .'S s
(Name of Property Owner)
property located at t h {r 1?1 r t Fo4 N 3A`?
(Lot,Block,Road,etc.)
on 04 2UE!, C' J Y_ , in 411..‘17'aD') ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#: acia'.' 3-Ob3 Mailing Address: \O33 {Yvi--Y►fliAi1
Somas , ta.[ 25
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.)
nA 1 e I do not wish to waive
1141 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)
lb - /1E1"iDiAN u)A9 Signature
Mailing Address
/ I I

k
ANTINORI CONSTRUCTION CH O Q America.
145 VIRGINIA LANE A R(f 5300196
SNEADS FERRY,NC 28460
[phone] 66-19-530
PAY TO THE ^
ORDER OF:
MEMO C1� 53 I3d `en)
AUT IZED S GNATURE
00078610
.0 5 3000 196i: 000E 50 5 2 1990o

Consent for Use of General Permit 7H.1200
Lot Number/Address: % ‘g.c.j
County:ESvo,..-) Subdivision:
Criteria:
(check all that apply)
a' Primary Nursery Area.
Less than 2.0ft deep.
❑ Greater than 2.0ft but less than 3.0ft.
❑ Submerged Aquatic Vegetation.
o Bottom habitat.
Comments:
OW VG rtolivi eA,4 S n4 Of u.St. BPS
Decision:
❑ Issue General Permi
• Elevate aj!,©!;- it
sd)-
NC Division of M /Fisheries epresentative Date
/ it1/' /% 6vff
21 4,2kg, 2eo'h