54926_NC DOT_20100107 (2)

Applicant Name
Address T O r t'
City c771 StateC,.ZIP
Phone # Fax # O
Authorized Agent /
Affected ❑ CW ❑ EW PTA ❑ ES C P s
AEC(s): ❑ OEA ElHHF ElIH ❑ UBA [IN/A
❑ PWS: ❑ FC:
ORW: yes / Co) PNA yes / Crit.Hab. yes /
Type of
Pier (d
Platf
Fing(
Groi
Bulk
Basir
Boat
Boat
Bea(
Othi
Shor
SAV
Sanc
Mor
Phoi
'ICAMA / ❑ DREDGE & FILL
r. GENEP
jkL PERMIT 1
N'eVoclification ❑Complete Reissue ❑Partial Reissue
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_
�� (✓ Rules attached.
Project Location: County :Sc -•�;1+,
Street Address/ State Road/ Lot #(s) Oy,��`'�,.�
Subdivision
Previous permit #
Date previous permit issued
110410
,6 9?16
J
CLL ZIP
ity �1 Z���� �° 7
Phone # (_) River Basin
Adj. Wtr. Body �;0{ n v- eA �( at, man /unkn)
Closest Maj. Wtr. Body
/ 4,
(Scale: )
rrm(s)-
--,
- -
-.
_
i
-
__
rlengthr pier(s)
number
lead/ Riprap length
1
avg distance offshore
max distance offshore
_
}
;.-_j_
_
—
TI`
_4--_
��
-
j
�- .- --
—
� -
I--
I
i
I
, channel
—
— —
—j
-44
`
-
—
�
cubic yards
I
ramp
—
—
—t
-.
—
-
louse/ Boatlift
—
r
--
Bulldozing
r
ZIA
--.--
.,
_
rrN
Lx�I
---
—
_line Length�-
not sure yes
�ags: not sure yes 861
rtorium: n/a yes
as: no
'
H1
t
f
-
-
—1
Waiver Attached. yes ntj.
A building permit may be required by: A`'>r" yx)"It +-' ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
,9
Signature 4PIe ead compliance statement on back of permit"
Application Fee(s) Check #
Local Planlilklurisdiction Rover File Name