54926_NC DOT_20100107

rCAMA / E DREDPE & RIM,FIM, tx
I
GENE L PERMIT Previous permit#
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 I SA NCAC :��
i ,Rules attached.
Applicant Name {J Project Location: County
Address �T o r Ci(7 Street Address/ State Road/ Lot #(s)
City t,�7'1 State )C,rZIP,<.:,,
Phone # (____) Fax # (__)
Authorized Agent
Affected El
CW ❑ EW PTA ❑ ES YP7S
AEC(s): ❑ OEA a HHF a IH ❑ UBA � N/A
❑ PWS: ❑FC:-
ORW: yes / Co) PNA yes / i�)
Type of
Pier (dock� length
Platf
Fing,
Groi
Bulk
Basil
Boat
Boat
Beac
Oth,
Shor
SAV:
Sand
Mor.
Phot
Wain
Crit.Hab. yes / 'COD
Subdivision
City L �i Z11, ZIP -
Phone # ( ) River Basin
Adj. Wtr. Bodu /man /unkn
Closest Maj. Wtr. Body i� >C K,
3(ZA Ix = Z 3
i
(Scale: )
arm s
�r pier(s) - - —
i length -
--
-- - -
- --+
-�
i -� -- -'--
—
- -
17
number
lead/ Riprap length—
avg distance offshore
max distance offshore
channel
�---
i
i
I
cubic yards
ramp
T--.- -
-
—
-
iouse/ Boatlift
i Bulldozing-
r1{.oT
I
i
,
aline Length
not sure yes }
gags: not sure yes
torium: n/a yes Crib-
)s:---
er Attached: ves (nod
—1
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Name
Signature PleSvread compliance statement on back of permit
Application Fee(s) Check #
IV
Local Plan-11kiurisdiction Rover File Name