54911_NC DOT_20100203

„t(� DR GE &FILL
GEN PERMIT vPrevious permit #
I - Vdification ❑Complete Reissue ElPartial 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 a`
Rules attached.
Applicant Name Project Location: County'
N
Address
Cityn State- ZIP S t'o
Phone.# (��) -1wZ` V7 :7- Fax # (ZZ) W7 $7Z�
Authorized Agent /4 y td I I# u'�
Affected ❑ CW ❑ EW DTP A ❑ ES APT
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes /:ffqF PNA yes %na Crit.Hab. yes / ncC-
Type of Project/ Activity I
Pier (dock) length
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
Beach Bulldozing
:�)CiC._
3 2 71
=...Other iyi
?(J
okl�rrc
Shoreline Length
SAV: not sure
yes (,n
Sandbags: not sure
_yes n4-�
Moratorium: n/a
yes,` no '
Photos:
'yes' no
Waiver Attached: yes,-_ti,;-;no.
Street Address/ State Road/ Lot #(s) A_ ` �:Z �' 2
Subdivision
City t-��X��Y” ? ZIPS 2�
Phone # ( ) River Basin?
Adj. Wtr. Body_�LtWr5 Cl-effiat)/man /unkn)
17
Closest Maj. Wtr. Body I'q 'S °` v 04 tl 0
a
i
� i72 4,1 �V-
(Scale: )
ONE
IM
Em
0
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IMEF
MOMMENEXIM
MIN
IMENIMMIN
0
MEN
INSESEEMEN
MOSEENE
EMEMMOMMEM
MEM
MIME
MEN
SMINMEM
NEEMNE
SO
MEM
MESON
ME
ON
0
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A buildingpermit may required b : ` jz' '��'—
p y be re q y (l El See note on back regarding River Basin rules.
Notes/ Special Conditions 1pt.�i►�C
I Q YI/ 07 V 1`y-1 {':,� �,f� V/�
-x-)XI 01
Agent or plicant Printed Name PkrmitOffiicer's ignature r �a
Signatur Please read compliance statement on back of permit Issuink Dat ` Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name