General Permits (4968)

Ll CAMA / -]DREDGE &?FILL
AGENERAL PERMIT Previous permit #
QNew ❑Modification ❑Complete Reissue I] 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 1 SA NCAC`_ J
i - DRules attached.
Appiicant Name , J ; a •. , i , ; _ Project Locatic n: County
Address `;''�� t/- �'� Street Address/ State Road/ Lot #(s) ►'� ��.
City State r� tk( ZIP -
Phone # ( -?) '"� —�' " Fax # O Subdivision
Authorized Agent City ZIP
Affected El CW ❑ EW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
0111w: ;% yes / no PNA yes f no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Phone # (_) River Basin
Adj. Wtr. Body l't )"' t a..'... t, rs t man lunkn
Closest Mal. Wrr. Bony 1 - ^ ;C
(Scale:
C: v ti v
WTL
Boathouse/tBoatlift - !___r-
_
Beach Bulldozing
Other
- \7
Length i ��`
•
Shoreline
, {, , V 'r
SAV: not sure es
no
Sandbags: not sure yes
+ o
Moratorium: n/a yes
- -
-
-
Photos: ores
no
Waiver Attached: yes
no
A building permit may be required by: `. -
y ` I
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
_ � . � t: •'- - ' -i-� - , r "'`r '
� � � ` _ i• - { �"-, 1 l 1� i :lit (_CC_
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit*
Application Fee(s) Check#
Permit9fficer's:Signatur6 {
Issuing pate i. �ipiratlon Dat
750
LdcafPlannin¢ Jurisdiction Rover —File Name
i