53278_SHEFFIELD, STEVE_20090408 (2)

LAMA DRED4E&FILL�s IOUEN 1 �� B
dew odificatio El Complete Reissue C 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 15A NCAC
Applicant Name
Address
City P7B V15R ? State ZIP
Phone ,# (9aY , L Fax # (_ )
Authorized .Agent BOW P)VRKa
Affected El CCW [I EW [I PTA ❑ ES ❑ PTS
AEC(s): ;kOEA �HF ❑ IH [IUBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / (-) PNA yes / ® Crit.Hab. yes /
Previous permit #
Date previous permit issued
WE
Project Location: County
Street Address/ State Road/ Lot #(s)
4-) -A Al Y)�
Subdivision j,
City � 4)gbyiLi ZIP
Phone # (
River Basin I/J7" ?V—
Adj. Wtr. Body �rLAVTiC ®C&MV a man /unkn)
Closest Maj. Wtr. Body 9T LAA,1 C- dC6X[U
Type of Project/ Activity RN D6WaS
Pier (
Platfc
Finge
Groir
Bulks
Basin
Boat
Boat
Beac
O&
Shor
SAV:
Sand
Moratorium: /a . yes
Photos: }yet
Waiver Attached: yes
no
P
A building permit may be required by: y���� 1y, �'�J� }-��❑-i See note on back regarding River Basin rules.
Notes/ Special Conditions _ Cu_� �R/)I% �t- �iiT 1`f+�ty�'/` P;x )qPJ) {L LM4L ropy IT/ AZ
IN
Agent or App � ant Printed Na
Z-1
Signatu lease re„ad compliance stateraenton.back.of.permit:;
V
Application ee(s) Check#
Permit
5-/
Issuing DatLI ' I Expiration Date
ahA lk C()9NO?B
Local Plan ing JurisbiEti& Rover ile Name