42395_BARKLEY, KARL_20050916 (2)

1—E6AMA / ❑ DREDGE & FILL N o 421195
GENERAL PERMIT Previous permit #
[R flew []Modification ❑Complete Reissue []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
) 0 Rules attached.
Applicant Name Project Project Location: County
Address_ 1772-tV fl%,' rst(� �/Street Address/ State Road/ Lot #(s)
City State •�%G " ZIP ZC{i. _ �`7�e►� L-
Phone # Fax # O Subdivision
Authorized Agent City ZIP
Affected ❑ Cw ❑ EW P-PtA Al ❑ PTS Phone # ( ) River Basin t
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body ( ,/ kn
❑ PWS: ❑FC: nat un )
ORW: yes /6p PNA YP no Crit. Hab. es / no Closest Maj. Wtr. Body do",Jc
Type of Project/ Activity //'D dt7 S e/f /1 &i! Adl f eAi '*" 'eY1C79&g Si��� A. er e r ---
���� (Scale: ;�t�W )
Pier (dock) length tt
Platform(s)
_•_ i I I I J_4� t %_�I
Finger pier(s) I i_
I 1
Groin length i — I i --
number
ulkhe / Riprap length
3_
avg distance offshore
max distance offshore f
Basin, channel �—
cubic yards j
Boat ramp —�
Boathouse/ Boatlift
} 1 I
Beach Bulldozing
Other
-TiAlll-
Shoreline Length %7
SAM not sure yes , o
Sandbags: not sure : yes no --`"—
Moratorium: n/a yes no -- — — n
_ _- -- — —
Photos yes n Waiver Attached: yes
A building permit may be required by: A4161ILS %j t
Notes/ Special Conditions
rent 6r Applicant Printed Name
❑ See note on back regarding River Basin rules.
Pe�tOfficer's Signature ..
Issuitfg—Dat- Exp tion Date
Application Fee(s)