60115_PARKER JR, ROBERT_20120503 (2)

CAMA / DREDGE & FILL le" • ;' `x j `°
RECEIVED 1 l/Jnl
GENERAL PERMIT Previous permit # N)
New ❑Modification Complete Reissue -Partial Reissue Date previous permit issued
r E�
As authorized by the State of North Carolina, Department of Environment and NaiuiPhl f 4LAV
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name6 f iiject`L 'ton: Coun61r4liC0
.
Address r Street Address/ State Road/ Lot #(s)
City_L '�_5
Phone #
Authorized Agent
❑ Cw `-N�rW
Affected
AEC(s):
❑ OEA i ❑ HHF
❑ PWS:
ORW:
yes 16�) PNA
Type of Project/ Activity _
State ZIPQ
Fax #
O
s<PTA —Its ❑ PTS
❑lH ❑UBA ❑N/A
_ ❑ FC:
yes 7V
0
Crit.Hab. yes /(9
s
Subdivision
r City ZIP
Phone # () River Basin.
Adj. Wtr. Body S' na man unkn
Closest Maj. Wtr. Body
d (Scale:
Pier (dock) length t' K _ .. -- -
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 Bulldozi
Other
Shoreline Length
SAV: not sure
yes
-
-------�
Sandbags: not sure
yes
_�•=�
Moratorium: n/a
yes
OV
Photos:
yes
y .
Waiver Attached:
yes
A building permit may be required by:
Notes/ Special Conditions
or Aoo'ficant Printed Name
r , _o -
-- -
Signature''WPI`ease read compliance statement on back of permit"
76173
Application Fee(s) Check#
See note on back regarding River.Basin rules.
Issuing Date / %� f pirati Date
Local Phinnibgjuriscliction Rover File Name

UNITED,P--
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Fbt Cfambl it,
• Sender: Please print your name, address, and ZIP+4 in this box 0
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CcnSTp-UC71 10
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�7..111 Complete items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery is desired.
§ . ■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
40 s� I
❑ Agent
❑ Addressee
Received by (Printed) ,Name) C De
�_t,��uCp�L( r
D. Is delivery address different from Item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. legice Type
rtifled Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7011 0470 0000 7751 4004
(Transfer from service label)
PS Form 3$11, February 2004 Domestic Return - ReturnReceipt &;�?`� 102595-02-M-1540