54293_MORELAND, STEPHANIE_20100112

O�'NF�'
C! =DGE & FILC—�odiPERMIT Previous permit #
ation 'Complete Reissue -Partial Reissue. Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources —7 a i,
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant NameXIIPIVI�y L Project Location: County ',� ` i
Address Street Address/ State Road/ Lot #(s) /S
ctyi�t'�` StatelA zIP 3 L)�'s'�'1.'TI;t" %41
Phone # ( }� Fax # (_) Subdivision o l Al)*,s #1w
Authorized Agent 171T7K S70Ju City 1 q /fir Mar) ZIP
Affected El
CW YEW *PTA ❑ PTS
AEC(s): El OEA ❑ HHF C IH ❑ USA 0 N/A
❑ PWS:
ORW: yes /(nd) PNA
Type of Project/ Activity _
❑ FC:
yes Crit.Hab. yes /
Phone # (_) River Basin "#--
Adj. Wtr. Body. ROAA VA-,i '50j A1V (>a man /unkn
Closest Maj. Wtr. Body R e amp ir-'s'em ig
Pier (dock) length
Groin length
number
Bulkhea Riprap length_
avg distance offshore
Shoreline Length
_ A
SAV: not sure
yes
n —
T
Sandbags: not sure
yes
n
Moratorium: n/a
yes
+
Photos:
e
i __�
Waiver Attached:
yes
no
A building permit may be required by
Notes/ Special Conditions
Agent or Applicant Printed Nam
(Scale: fflf
N9. 5 0 u ❑ See note on back regarding River Basin rules.
6
Signature '* Please read compliance statement on back of permit"
7O
Application Fee(s) Check #
Issuing Date f 0 EApiration`Date
Local Planning Jurisdi ion over F le a e }