44225_WITHERINGTON, ALONZO_20060207 (2)

[CAIVIA /.P-6R112DGE & FILL
GENERAL PERMIT
re
Pre
ous
L;4New DModification [-]Complete Reissue EPartial Reissue
permit#
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
Applicant Name 7 r, W�44y)
E] Rules attached.
Project Location: County
Address 6 0 V5­ t,/, T-f-
Street Address/ State Road/ Lot #(s)
CityStateP/C'rs
a-7 S�:'
Phone # Fax #
Subdivision ---
Authorized Agent
City ZIP
D Cw E•Evw 1� El PTS
Affected
r[-]UBA
Phone # River Basin
El OEA D HHF El IH El N/A
AEC(s):
Adj. Wtr. Wtr. Body
/man lunkn)
0 PWS: 0 FC
ORW: yes /8 PNA yes Crit. Hab. yes no
C,
Closest Maj. Wtr. Body
e--/-
Yew
Type of Project/ Activity
(Scale: /Vb"
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
avulkRiprap length
headistance offshore
max distance offshore
Basin, channel
T—
LP
N
-4�
-4
cubic yards
Boat ramp
Boathouse/ Boatlift
t
Beach Bulldozing
Ap,
Other
1.o
mom
S'o o
Shoreline Length I
SAV. not sure yes no -AY
Sandbags: not sure yes
Moratorium: n/a yes L
Photos: yes no 1111
Waiver Attached: yes no
A building permit may be required by: E�-fee note on back regarding River Basin rules.
Notes/ Special Conditions
4"J
Wl-r-7h- ,�P1'1vq7,nL-
Agent or Applicant Printed
SigA/atur Please reVcrcjorEpllia�ncstatement on back permit
��/00' 00 S'*11 Vq3363
PermiMffic4ls Signature A3
Issuing Date Expiration Date
Local Mannino Itirisdiction Rover File Name

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PUgCHgSER, SIGNER FOR DRAWER
PURCHASER, BY S16NING YOU A(;1EE TO $IE S"cRVICE CHARGE AND OTHER TERMS ON THE REVERSE SIDE
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