44919D - Zolzer

CAMA/ F DREDGE & FILL i
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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
2oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 4 14 _ t Z�,IIVRules attached.
t Name jAM e,S :j 7-t le Project Location: County Q N S LL l•'J
I -2.- E ?I--IT F 1 LlO I.AJ Ay Street Address/State Road/Lot#(s)
0IMF Sal k-4.-,E State NC ZIP Z..$117- IN A TrYZW A y
•( tt 7 -•j I 0 Fax#( ) Subdivision
.ed Agent A L, Eial&AT0 L- City 5+.1C-A-OS - 1 ZIP Z.s Li-E
J'W R tW Ni f A ❑ES ❑PTS Phone# ( ) River Basin Nf,Jvv
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body A i W V\,' 'm/
❑ PWS: ❑FC:
es / PNA yes /'9 Crit. Hab. yes / no Closest Maj.Wtr. Body Sni/li/2 SDUO.)D
f Project/Activity I? Pot 12 E.7(1Tl tt1C� iv(Ey— i2EPLA GE T- tt-E-=fin
4 ( - )C I 5�I M 12 5 (Scale: I _
ck)length 12,0 ' X
i(s) 24-'yc i (7
ier(s) A I W Y r —
ngth ,
mber _ _
d/Riprap length 1,1 I l
i distance offshore i .-_A
a distance offshore
cannel / ..../
"l)
bic yards
np t'AV"i • y
ise/Boatlift —177
}
4
ulldozing_ bsn_ `!. ' ik
ie Length lj 0 ,
not sure yes & 1 _ -., L✓_�r
;s: not sure yes (i L 1
cum: n/a yes or2.S 7 v i K�1A/f1 , ,),e
yes
Attached: yes '(J
Ing permit may be required by: )hjSLUy\/ • See note on back regarding River Basin r

•
5371
ANTINORI CONSTRUCTION BANK OF AMERICA
135 VIRGINIA LANE
SNEADS FERRY, NC 28460 66-19/530 3/�A���
[phone]
PAY TO THE / 'fob .
0)
ORDER OF N, C• i//��. It - /Y- A $
":2)a EDt J& D RAM) / DOLLARS
�(7 zc -- v�I�
�_/� AUTH4404/
MEMO - 2'�2�`�
� ����� L 00053780 1:053000 L96i: 0006505 2 L9901I'

Jr!I 1.1J.GC)CJJ .L1'-$Or'111 11,.LL11I\ wlI\v I """'�' .—
1
DIVISION bF COASTAL MANAGEMENT,
AD.1ACENT RIPARIAN PROPERTY OWNER NOT Ca TjON/WAIVER FORM
Name of Individual Applying For Permit: s .,-
Address of Property: •
(Z.ot or Street#, Street Road)
City and County) ,
I hereby certify that own property adjacent to the above-referenced property. The individual
applying for this perm.t has described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions,should be provided with this letter.
1// I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
set bck a minimum distance of 15'from my area of riparian access-unless waived by me. (If
you wish to 've thel,setback,you must initial the appropriate blank below.)
v
" I o wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement.
--4/ 1444 1 '/ ......, .......,_.
72 '17.1 , .. .........
Sign Name Date
(di:/i, , \vp--4, 4--_,
Ala
Print Name
//%�A/2 - i NCDERR
` �� _ N1 G+,pIJMo•dVMRfT1RNt o1

I, j 2 017.ee X20t2rr , give authorization to
Antinori Marine Construction to act as the
contracting agent in obtaining and signing for the
requested CAMA permit.
Job site address is: 9-5 Gc>o��*'ri,uq { ,,t.
Srosfrr ; ri c_
My permanent address is: re( c �q
Yvldovesut( L 14
c9 i l7
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. X - , El Agent
• Print your name and address on the reverse , ❑Addressee
so that we can return the card to you. by Printed Name) C. Date o Deliv-ry
• Attach this card to the back of the mailpiece, , ,
or on the front if space permits. ��
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: if YES,enter delivery address below: ❑No
Ea)cL(NIZS) P- S s

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