20036D - Mayo

CAMA AND DREDGE AND FILL
GENERAL 1 a' 120136 —1)
-1�
PERMIT
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 7 . Ig 00
Applicant Name e—bAjt6 W n()Nin Phone Number l IU 5 &-8:61 1
Address P 0 ]UX 33 0
City W r ,c kt so, 11°t.._ -a,e c k State K.K../ Zip 8 Lie()
Project Location (County, State Road, Water Body,etc.) A 1O4 (to LA r' ' Ti, C Ur/Ne Ark
��1`�` nds 'Y i Arl‘ tl\nc'‘ l\f\ IrJA I\)or+1.-. T sri� 1 -nc Wt) n- Ali* C -1
Type of Project Activity M b\a 1 k -AC.) l NCAn.) b0(1k `Of) , r1 14 Y. l'
"---bu\K- -\Ac-O must- be \ MuJfC aF (0f\ -t ) 1 Metrsh cv nSS
PROJECT DESCRIPTION SKETCH (SCALE: NO 7 TO )
Pier(dock) length fi U __ �� O)4( _ -1 -1 —
Groin length
IA
is
number Gs 1 `
Bulkhead length W
0
max.distance offshore_SI 1 C V cU.s` ci
C \'--___bUiaA br, k r` a'KYVN 1 ,
Basin,channel dimensions
\ , f/
Qcubic yards i (`i'
Boat ramp dimensions _ P(URA)SC
L �/ 1 bv,l Vic(
Other . )--
e' `�' I ck)LA1KhCnd
710c_,
This permit is subject to compliance with this application, site
( _____7
drawing and attached general and specific conditions. Any4c:;(___
(M' /�1.�'t �J
, ,,
violation of these terms may subject the permittee to a fine, ^ `
imprisonment or civil action; and may cause the permit to be plicant's signature
come null and void. �,
This permit must be on the project site and accessible to the
permit officer's signature
permit officer when the project is inspected for compliance. �^GG ( i GCS
The applicant certifies by signing this permit that 1) this pro- 05 1'1 I I C� j 1ci`' I
ject is consistent with the local land use plan and all local ) issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no 4-1 , is 00 c . ISO 0
objections to the proposed work. attachments
In ,«i 1;nr, thin r.o rmit tho Ctato of North Carolina rortifioc that t- 4 A O/i

L �Lr�� z r Lv l.r U 1 ..R FORNI
ADDITIONAL NA1\ES:
AEC DESIG: ES t l P 1 DE:VrLOP AR A _Q 3 PROJ DESC: P -(ll Ii 1 only takt.6) 1
(Will and).take I)
'WORK: lbI 6 xmay' i) H 96 Y. iO
only ask:4)
MkfN'T:
r� <<
(Will onlytaicr 4)
(wM only take 6)
ACTION EXPIRATION
DREDGE et FILL REQUIRED: - ) 2 5 1 9 8 )zs )
CAMA MAJOR DEVEL REQUIRED:

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/0 '-9 es-As.i c _ .e CS Q
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1,41 m t,-S Q ,r�0 s�•,.
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Compliments of
Linprint Company- lLai

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit:
Address Of Property: G c` G 6..sl(c•Le $e __e���
,o '?f3..z-,'c ,' r9c 4, nl--6_ - *6.5
(Lot or Street #, Street or Road, City & County)
I hereby certify ' that I own property adjacent to the above-
referenced property. The individual applying for this permit has
described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be rovided with this letter.
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 , North Carolina , 28405 or call 910 395-3900 within 10
days of receot 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, lift must be set back a minimum distance of 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. )
7 .
k I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
sx; ,- -,4 .>7)e, -- c-- ‘97-Y7 t AwcirA
4 /22 iiv s, mE,
),. 1.,tu,rt ate JO
Pri Name -,_ a v i s-6 7 . r
Telephone Number With Area Code H NI Fl

;; SENDER: I also wish to receive the
v •Complete items 1 and/or 2 tar additional services. • following services(for an
N ■Complete items 3,4a,and 4b.
a) •Print your name and address on the reverse of this form so that we can return this extra fee):
card to you.
> •Arch this form to the front of the mailpiece,or on the tick if space does not 1.❑ Addressee's Address
m per zyt. ` 2.❑ Restricted Delivery
i
d ■Write'Retuf RebeipLeequested"on the maiilpiece,below the article number. rY
w ■�IAe Return Receipt wit shdwto whom the article-was delivered and the date
delivered. Consult postmaster for fee.
0 3.Article Addressed to: 4a.Article Number
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2. �.7f 7,26) QgC
a 4b.Service Type
o 9 ,�1X- 3 2 ❑ Registered Certified
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❑ Express Mail Insured
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O 7. Date of Delivery
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¢ 5. Rec .d By. (Print e) 8.Addressee's Address(Only if requested
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tx 6. Sign ur ee or Agent < I.
2 PS orm 1 ember 1994 102595-9e-B-0229 Domestic Return Receipt

a; SENDER: I also wish to receive the
v •Complete items 1 and/or 2 for additional services. following services(for an
N •Complete items 3,4a,and 4b. • •
a) ■Print your name an)address on the reverse of thix'aQa--JOW we can return this extra fee):
card to you.
,11> •Attach this form to the front of the mailpiece,or on the back if space does not 1.El Addressee's Address
e, permit.
■Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery
w ■The Return Receipt will show to whom the article was delivered and the date
delivered. Consult postmaster for fee.
c 3.Article Addressed to: 4a.Article Number
Jra d 0111.1 '- a y71 -)Q 7 q 3
IL 4b. Service Type
o �.5 ( CI Registered *Certified
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..--tops CI Return Receipt for Merchandise ❑ COD
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o p y f _ 7. Date of Delivery Gl
4
¢ 5. R]ceived BB • rint Name) �/� , 8.Addressee's Address (Only if requested
❑ 1._,�' / /✓r r ��/a`yZ yL and fee is paid)
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fi 6.Sig tur (Ad ee or Agent)� t �
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2 PS Form 3811,December 1994 102c95-98-B-0229 Domestic Return Receipt

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ANTINORI CONSTRUCTION 816
896 I I WY.210
f IOLLY RIDGE,NC 28445 �- L J.�q 66-19/530 NC
Date l / 6070
Pay b the �� k ;�
Order of �. I V (� 1 $ .-0 �---
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