59097_TWIDDY, MICHAEL_20120508 (2)

fCAMA / p DREDGE &FILL
GENERAL PERMIT
-M, 14 ;?6L, Previous permit #
1New ❑Modification DComplete Reissue OPartial
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 I SAA%pAC I t
.Rules attached.
Applicant Name
Project Location: County � -
//
Address �(P k
Street Address/ State Road/ Lot #(s)
City , 7y StateNc ZIP VION
DR(%It
✓ -
Phone # (�`� � -32 Fax # ( )
Subdivision 6 fi) r& I p r
Authorized Agent
City_` ZIP 7
Affected ❑ Cw EW r PTA Q ES ❑ PTS
Phone # ( ) River Basin N! W7
❑ OEA ElHHF ❑ IH 1-1UBA El N/A
AEC(s):
^�
Adj. Wtr. Body �s na man unkn
❑ PWS: ❑FC:
ORW: yes /' nd. PNA yes / Crit.Hab. yes / no:
Closest Maj. Wtr. Body
pp
Type of Project/ Activity r L_2�
Pier (dock) length
Platfc
Finge
Groir
• B.1 .
Basin
Boat
Boad-
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Shore
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Attached: Yes
A building permit may be required by:�
Notes/ Special Conditions
Agent or Applicant Printed Name
Signatur Please read compliannce'statemehjn back of permit 1b by
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit
Issuing Dater Expiration Date
Local Olannlngjdrisclicti& Fover File Name