44918D - Hall

'CAMA/ L1'DREDGE & FILL .
3ENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources �j
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 4
'Rules attached.
t Name PA"TW I C 1 Pk 1-k" L-lr Project Location: County (,A./cL Duo
�O j j 12 12.O O . Street Address/State Road/Lot#(s)
N t Sl S /k Fsz ia, State NG ZIP 2L+ (� (.9 I Z t)
�t (�D
( EQ S2� 5-3 (Fax#( ) Subdivision
:ed Agent A l - ► ,E I GI-MD L City 5/./E-A-os Fr72.z y ZIP Vfrfo
CW c4'EW .a PTA [DES ❑PTS Phone# ( ) River Basin
❑OEA ❑HHF ❑IH E UBA ❑N/A Adj.Wtr. Body f iF(N k) V 6R_ nat i
PWS: ❑FC:
yes /� PNA / no Crit.Hab. yes / no Closest Maj.Wtr. Body` i "�
Project/Activity C Q rj 51 t2-)C. A 1J�N/ C 1 I.Kt-tEA0
(Scale: _
ck)length
1(s)
ier(s)
ngth
mber
Pra P length gt 7Zt
distance offshore
ixdistance offshore N v . I`i V 1. "-
cannel
sic yards
np
Ise/Boatlift
ulldozing
S
t; � � r~k�cTr
e Length 5s. • L
not sure yes I j Lr t� j� 1 y'
s: not sure yes o
cum: n/a yes
yes C'-
kttached: yes no
ng permit may be required by: ONSLQ r.I (0 See note on back regarding River Basin n

5378
INORI CONSTRUCTION BANK OF AMERICA
135 VIRGINIA LANE
SNEADS FERRY, NC 28460 66-19/530 /�
[phone] 3/rn#9? 't
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_ ,P. $
HL.)NO�Ji0 AA/0 (/er) DOLLARS
8 aAUTHO ZED SIG URE
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000 5 3 7811' I:0 5 3000 L 9 6i: 000 6 50 5 2 L 9 9011'

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A
I, p - Li� l41/ , give authorization to
AntinoriMarine Construction to act as the
contracting agent in obtaining and signing for the
requested CAMA permit.
,,, -;;(- --/tcz,,,___ - .
Job site address is:
/ // 4Au __rr __s - Net
an
My permanent address is:
&7l/ IL .
,_5-i/u• -is Aiiiy AM- , 9 V/17/k?
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. ' 0 Agent
• Print your name and address on the reverse X iilL , _ mi. ,. ' .,_% \% ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece, '' _ 6_��
or on the front if space permits. `- 1. `
D. Is delivery address different . item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No

- DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OW NOTIFICATION V RM
Name ofindividualApplyingForPermit
Address afProperty_ 4 i/•
mar Street#,Street orRoad)
/0e1WW N /z ) /-#
( )
hereby certify' that I own property rafjacent to the at ed property The
pplyingforthispermithasdesabedtomeassbown.aatheattached diawinathe development*
rej A boa or drawing,with ernnensions,should be providedwith
/' Piave no objections to this proposal _
You have objedi'oas to what is bei®g proposed, please write the
Carermil NC 28405 or calf 91
at 10 of8
00
ithi
receipt ofthis No response is eonsidere&the same as no ob
jecleal
u have heea notified by Certiled lam,
WAIVER SECTION -
�that a- dock, Wogs,breakwater,boat house or boat Mt must be
instance of15'from my area ofripariaa access-unless waived by me. (19
t wish to waive the setback,you mast iaifal the appropriate blaesk below.)
I Fin wish to waive the I3'sdbedk requirement.
meat
I do not wish to waive the Li*sdbecknquirement
[Name - Dale -
/ 1 - AMA