55669_LASSACK, ALLEN_20100716

CAMA / DRlEDGE & FILLS,
C NE PERMIT PERMIT V//Previous permit # .-
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
[Rules attached.
Applicant Name CALtQ '�1 5� Project Location: CountyJ��! 1I ;'j CLlt
Address r 1 cj�l! Q Street Address/ State Road/ Lot #(s) �tj - �az
City State_L 1C , ziP_.i tit
Phone # Fax # O Subdivision
Authorized Agent Cizip ,3-'7
Affected ❑ CW 11'PTA [IES ❑ PTS Phone # ( ) Rier Basin a ' LL 1.
ElOEA ❑ HHF ElIH ElUBA ❑ N/A y V
' AEC(s); -Adj. Wtr. Body ! j � nat an lunkjn
❑ PWS: ❑FC:
I,`-. Closest Maj. Wtr. Body � f 'y ^
ORW: yes / no PNA yes no Crit.Hab. yes no y
Type of Project/ Activity i (i ' '.1 ; }� ! o I. i �` } & r
tale:
cS
Pier (dock) length
Platforms .
Finger pier(s) - - - - -
Groin length.. T
r
number t
J- -
Bulkhead/ Riprap length
avg distance offshore
max distance offshoreJti
Basin, channel I I t
----i-
cubic yards
Boat ramp -- - - - _
Boathouse/ Boatlift
t— -�- - -- -- -- - -+
Beach Bulldo - - — +----,--- - i
Other 'M T 1 f IC -
Shoreline Length __ _ I �
r�-
SAV: not sure yes no _- -
-- i
y
g yes
Sandba s: not sure
Moratorium: /� es no
Photos: no J1��
Waiver Attached: yes
A building permit may be required by: �_ ❑ See note on back regardilg River Basin rules.
Notes/ Special Conditions t
Agent or Applicant Printed Name
i
Signature Please read com +ante statemen on back oermit **
�, o6
Application Fee(s) Check #
Permit
t'
Local Plannine
4 j V
Exp i ! tion Dale
Rover File Name