53435_NC DOT_20090701

-� �CAMq/ C3DRE GE &FILL ///
G E N E P E`"t�`T N ✓ Previous permit #
�ttVew odification ❑Complete Reissue`?—LI rtial 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 -
L Rules attached.
Applicant Name__A,,,) Project Location: County Y>
r�� r'� ��. = �- Street Address/ State Road/ Lot
Address �' / K ' `
City r r' 'r77i State.,QC.
Phone Fax # 7 Subdivision
Authorized Agent CityZIP _�� 7l
Affected ElCW ;3 EW ❑ PTA ElES ,❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A :(nat, /man /unknAEC(s): Adj. Wtr. Body" ' all )
❑ PWS: ❑FC: :..'-
Closest Maj. Wtr. Body ., �,
ORW: yes /.-no' PNA yes / no Crit.Hab. yes / "no
Type of Project/ Activity -
Pier (dock) length
Platforms)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
(Scala;-=' )
610k i
i
i
Y -
,- n
Shoreline Length %o'.0
SAV: not sure yes no �. — --- — --! — - -- - - -- -
Sandbags: not sure yes no -- - i -- - - -
Moratorium: n/a yeses—na-_.
- - - - -
-- i_:_ - --- Photos: L.-,_)tes-•� no
y I
Waiver Attached: es no
A building permit may be required by: i s w- -- '� r �'� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Prin ed me )/ �__- P mr it0�icer/ Signature --
7 iog
Signature ** Please read mp iance{statement on back of permit ( Issui g Da><e Expiration Date
1,. jI, J
Application Fee(s) Check # Local PlanningJ5diction Rover File Name