37383_NC DOT_20040701

­,'F2CAMA / LINPREDGE & FILL -jo
GENERAL PERMIT A
Previous permit #
PINew ElModification ElComplete Reissue El Partial Reissue Date previous permit issued
N
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
VRules attached.
Applicant Name Project Location: County
Address— Street Address/ State Road/ Lot #(s)
L
City State NC_ ZIP IJ3)L !�%Jzaq-c KAQ
Phone #(-�)- Fax # Subdivision Q14
Authorized Agent OrV A I City�JaTy 1& IL. ZIP
❑ CW 0AW CfPTA OkES El PTS Phone # River Basin
Affected 7-\
OEA [I HHF 01111-11 El USA 0 N/A 6VF
El
AEC(s): El PWS: 0 FQ Adj. Wtr. Body at man /unkn)
— —*
ORW: yes / (n9,1 PNA yes Crit. Hab. yes Closest Maj. Wtr. Body.
Type of Project/ Activity K,50 I 1:&,--
U
F4
L
Pier (dock) length r T=
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore —
Basin, channel
cubic yards_
Boat ramp _
Boathouse/ Boatlift
A.
Beach Bulldozing
Other
0 A
Shoreline Length ----
SAV. not sure yes no
- ------ ---
Sandbags: not sure yes no -i :
Moratorium: n/a no
Photos: es no
Waiver Attached: yes
A building permit may be required by: va
Notes/ Special Conditions 1.
---- ------
4
47-1
iY11,
HE=
Agent or Applicant Printed Name
Signature **.,Please read compliance statement on back of permit
2,0216
Application Fee(s) Check #
(Scale:
7171.7 �7.
A450VO
T
- 7—F—,
T
MW Wilt
❑ See note on back regarding River Basin rules.
'2-
V-
I ,�_ _:.�- t
Y, I
Permit Officer's Signature
Issuing Date f ExpirStiontate
Local Planning Jurisdiction Rover File Name