53008_ROUSE, DWIGHT_20081107

,�L MD
,,���
�rG(A A / 'REDGE &FILL
GENERAL PERMIT Previous permit #
ELPPiew ' ❑Modification ❑Complete Reissue El Partial 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
❑ esattached.
Applicant Name - Project Location: County 1 - . I f,
r�.
Address, _ �- Street Address/ State Road/ Lot #(s)
City r� =�: i �-1 State )(�)P4
Phone # fax # ( )
Authorized Agent
Affected ❑ Cw Ew p.PTA Lr� LiPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs: ❑FC:.-.
ORW: yes //nod.) PNA yes / (b ') Crit.Hab. yes / no
Type of Project/ Activity � ( I f '
t
Pier (dock) length
Platform(s)
Finger pier(s) I
i
Groin length --
CBLlMr
ead//Upraplength
-;Kg distance offshore_�-
max distance offshore
�I—
r '
Shoreline Length
Moraconum: n/a yes ,no N ,
Photos: y s no_
j
Waiver Attached: yes) no --
A building permit may be required by:
Notes/ Special Conditions
Agent or A t Pr- inte�dame
(0�
Subdivision
City�7 zip
Phone # i ) iver Basin (/ r
Adj. Wtr. Body if t nat ma unkn
Closest Maj. Wtr. Body '
t
(Scale: &) 4S )
Signature PI ead compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
PermftOY iv6r's Signature ` "
Isshin D g Eykiic�_nDatj
Loc P in 4risdiction