42516_ALBEMARLE EMC_20050901 (2)

IA / ❑ D ' diS & FILL
GENERAL PEW T
New ❑Modification ❑Complete Reissue (]Partial Rei
Previous permit #
Date previous permit issued
As authorized by the State of North. Carolina, Department of Environment and Natural Resources "" 0
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC I r • /Lv ®�J
ules attached.
Applicant Name A16 C . A, t"t C.
Address 91 Q. $ • .6
City StatefJG
Phone # (!St,) 2,u 5 I-3S Fax #
Authorized Agent DAViJ 610sue a/,
11 �
AaVi�.9�oSSeAIl�nrl(.nGtmcS. (aM ��ir,�ifl �'
Affected ❑ CW ❑ EW ElES �TS
[IOEA ❑ HHFrTA
H El ❑ N/A
C ❑ PWS: ❑FC:
(AW: yes / no PNA yes / (G) Crit. Hab. yes / no
54
Type of Project/ Activity N- m i It s
to +& en t 3 (M•g.ta .PO k S) " `/N 3 M
Project Location: County WQADTA,k
Str feet Address/ State Road/ Lot #(ss) W )SR
Ylib�far•, ras/ira Alin�:n'��n ��
Subdivision
City
Phone #
Adj. Wtr
..s ZIP
( .�'' River Basin ��+ ° TP A BodytA(AnaM�1191A o{4
Closest Maj. Wtr. Body AS §4M a n K- T%"V ' '
t/V
(Scale: ATS
Pier (dock) length
Platform(s)
WAR
'
c
i
I
Finger pier(s)-.---
Groin length I
._
....
-.. I__
_
_
_
..
_
_
-_.I-_
.._I.:.
-I
i -
I
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
-;
L-=,
1
—
-
l�
cubic yards
I-
Boat ramp
A
--
I
i
I
I
Boathouse/ Boatlift
-
-
-
-
I
_
'
Beach Bulldozing
Other f fi tm, 'l-AG
+P:bve aC r� 5 s PTP
r� rc.3
_�_
77--
Shoreline Length
SAV: not sure yes G
`
-
Sandbags: not sure yes
Moratorium: S yes no
t
+
1161
l _
Photos: ye no
T1
1
Waiver Attached: yes Inns '_ _--
- ---
l
`
_.._..._—_..__. -- %.:s 11 Co.,to tP71 v- SFO ..fit1 STO,71�+
A building permit maybe required by: �115 tha0?menS� l ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions Tf • (� (��
Agent o Applicant Printed Name
i
nature Please read compliance statement on back of permit
f�*
g%un
Application Fee(s) Check #
e
Permit Officer's
ISSUOID14 Expiration Date
Local Planningjurisdiction Rover File Name