50300D - Comploier

XCAMA/ ❑DREDGE & FILL N9 5
GENERAL PERMIT Previous permit#
thew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC N • I/ - O O
Rules attached.
wit Name FQ-j--hE��-o-Y-- QP`'l PL,o:L7-;R.. Project Location: County OpSt ot.../3
Is Cl 09 N)G W L.tJ i, Its,y Street Address/State Road/Lot#(s)
Pt-,X State ti'C- ZIP 757S:::)2— 1-157_" L LH,.,1,••JT.i Ac cLC5
#(ci 15) Lob- .Z.S.S 1 Fax#( ) Subdivision
ized Agent.'(-\t)1 (LT City Socpo-.s c::-LI A-41 ZIP Z..Q q
d ❑CW Z EW /C PTA ❑ES El PTS Phone# ( ) River Basin W i-�
❑OEA ❑HHF E IH ❑UBA ❑N/A CG,ctva��
Adj.Wtr. Body- �rQ ��,^JD (nat
❑PWS: ❑FC: Si-vx<r P S o,.. ,_)
yes ' cJ PNA 4011 no Crit.Hab. yes / no Closest Maj.Wtr. Body
Df Project/Activity Z a STP L ,- rS.+c i l,Z F i tJ L x t 1 r &> f i T-- A S L+^
(Scale: 1
lock)length
'm(s)
pier(s)
length j
lumber i
;ad/Riprap length `l1 { i Jar
:vg distance offshore
nax distance offshore j
channel j
ubic yards N I
11
amp - I ! ilk I el:11
ws /Boatli i
Bulldozing _ o
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ine Length 1 cd t ..; l i , ,
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not sure yes CD \
cgs: not sure yes no I:
arium: n/a yes ©o I I I I L
yes (�o 1
r Attached: yes CO 1
Jing permit may be required by: CD 05LZ C 4 ' ' 1 I See note on back regarding River Basin

7424
Bank of America. �.
ANTINORI CONSTRUCTION '�j•
145 VIRGINIA LANE
SNEADS FERRY, NC 28460 66-19/530 /
[phone] L/aZ G/08'
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1. 28 07 05:08p p. 2
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
htihael F.Easley,Governor Charles S.Jones,Director William G.Ross Jr..Secretary
Authorized Agent Consent Agreement
ANTINo,21 ceN.TROcTio4 is hereby authorized to act on my behalf
(Printed Name of Agent)
-i order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
,pecific activities described in the attached sketch.
.00ATION OF PROJECT:
s/Sc22Ch1A0c.)/C4C Aa, S 49
nlEAr7.3 FeeR 9, !J C.
asy4.o
ROPERTY OWNER MAILING ADDRESS:
freceefic &r &oc
'909 AAwirt5,10%. Gvc
604„ / /vr . a7so.a._ PHONE NO. 9/9 - eeo6-a3`
UTHORIZED AGENT MAILING ADDRESS:
/H� v,R6i v/A A.A./
6 'JE,90.5 Fkl ,Pv) , Al C
of y6o
PHONE NO. VD "3oZ7-,34/7�
gnature of Property Owner.
/ , 6911,14-
gnature of Authorized Agent (1./AP-e4/7,

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