39939_DICKENS, MONA_20050131 (2)

C;A,MA�- DREDG1E 9 FILL
N ERAL PERMIT Previous permit #
Ilew ❑Modification ❑Complete eissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources ,r'
and the Coastal Resources Commission in an area of environmental concern pursuant to f 5A NCAC_ �!-G
7 ' ' '' , ` Rules attached.
Applicant NameNc�' Ij A 1 C h E hl Project Location: County t'
AddressljC.' {4 Cj 6 Street Address/ State Road/ Lot #(s)�
City State Uk L ZIP--� z2 V--) C' t Z7—
Phone # (_) C Z2,Fax # (_)
Authorized Agent
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Affected ," CW
; W ZfTA En 'ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF O IH ❑ UBA ❑ N/A
❑ PWS:
❑FC:
ORW: yes /
PNA yes / Crit. Hab. yes /fro
Type of Project/ Activity V A f j
Pier (dock) length
Plat,
Fing
Gro
Bulk
Basil
Boat
Boat
Beac
Oth4
\,/C
Shor
SAM
Sand
Mon.
Phot
Waiv
Subdosl-on
',9t V' ia-i i -7 s.JlA \h l tit, ,— ZIP Z�
Phone # ( ) River Basin. Fah
Adj. Wtr. Body
Closest Maj. Wtr.
?'mil U na man unkl
(Scale: )
irm(s)-
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n length
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number
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avg distance offshorei
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max distance offshore-
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cubic yards
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ramp
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■■■■■■
-louse/ Boatlift
►.■■■■■■ONONNIIN■E■OMINEn■■NoJN■■NONE
11 Bulldozing
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not sure yes
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NONE
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,agS: not sure yes ,�
■ONEONO■■i
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tOriUm: 7a yes no
ks: no
.r Attached: yes
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A building permit may be required by: T=iZz _ �(-t 0 See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or p i 't rinted Name Permit�O fi er's Signature
Signature Please read compliance statement on back of permit'`* Issuing Date Expiration Date
./ 'Q/i
Application Fee(s) <1 �Lj I t S Check# Local Planning jurisdiction Rover File ame