44920D - Burge

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.,CAMA/ _,DREDGE & FILL •
3ENERAL PERMIT Previous permit#
.'New Modification IIComplete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
2oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 771-1 , I j 0U �-1 i
Mules attached.
t Name GL t N ►JJ 12.,&E Project Location: County DNS-L.0!/1/
602 q (pm' S7. Street Address/State Road/Lot#(s)
v/2r- CT Ty State NC ZIP Z Lx IS (pot t 0 �? Sr.
( ) / Fax#( ) Subdivision
:ed Agent A.--y 6E lc,,,k.;To L. City SUer C cry
ZIP 26 y-it t
cw W PPTA C3'gS ❑PTS Phone# ( ) River Basin C/4r E
OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body
- PWS: ❑FC:
�/}t-(S7V/Y1 f�SrtiNO)at 4
yes / i PNA yes /6 Crit. Hab. yes / no Closest Maj.Wtr. Body AI w k /
'Project/Activity I2L PL A C E_X I STI 1,16 6vc. t-F-f-A-Q i4A/ 7 /4,.xE Pt..dA77 )42/A
(Scale: I"_
ck)length
1(s) j(r
ier(s)
ngth -
tuber r ti... ' ' c 1 " L.:
1/Riprap length Itt'
distance offshore /'
ix distance offshore J.1
cannel
)i c yards_
ip -- -
se/Boatlift
illdozing
- I I1«r'_>-- t',,;�.0 v
Length SS i___._._ / lc,et: M R�u IMLNC
not sure es 'F I I N/A'i 11 c ta.K YftcX"YZ7\) :..,t
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not sure yes i�L
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um: n/a yes o, :, tC i"c , ,"n--` . I
yes o F
attached: yes n�
ig permit may be required by: �� Si w-I ( f-ry . Li See note on back regarding River Basin ri

5378
fINORI CONSTRUCTION BANK OF AMERICA
135 VIRGINIA LANE
SNEADS FERRY, NC 28460 66-19/530
[phone] 3/MA906
$ yam -
HOMO/2Z-Z) ANo 7/40 DOLLARS 1
2- /2_� AUTHO ZED SIG URE
000 5 3 781I• 1:0 5 3000 L 9 61: 000 6 50 5 2 L 9 900

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ADJACENT PROPERTY OWNER STATEMENT
1 hereby certify that I own property a'rodent to s
` 11 (Name Of Property owner)
property located at
4 2
(Lot,dock,Road, etc.)
anArM+
s h 61404 ,in J pL ! ,N.C.
They have described to me as shwa below,the development they are proposing at that
location,and,I have no objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED
DEVELOPMENT
(To be filled in by individual proposing development)
t Awh►. ►_ A (£build O-e-0k
rgnature of Adj
14
Print or Type Name
ri ( v JD• 1OI -
Telephone?$umberr

I, , give authorization to
Antinori Marine onstruction to act as the
contracting agent in obtaining and signing for the
requested CAMA permit.
Job site address is:
c i7-5), A/ C
My permanent address is: