General Permits (6617)

4721
--CAMA / '__'DREDGE &FILL C^ s lT (�
PERMIT it 6
GENERAL Previous permit #
L-TNew .Modification _.`Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources tic 0
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
— ules a tached.
Applicant Name Y�/�w`�/'` __. Project Location: County w� ��ca
Address 00 _ Street Address/ State Road/ Lot #(s)
City State VkZIP - -- �� Vv•f �.✓
n
Phone # () �" �� 6 Fax # (_) / Subdivisions
Authorized Agent U 1 hi�/s'tco h f-�/�` cXl� City /'�w %Y r C ZIP
E_W fffTA � ❑ PTS Phone # (_ ) River Basin e,,4--
Affected - OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A !/Cf
AEC(s): Pws. ❑Fc: Adj. Wtr. Body _ _ _ _ _`�/y Hart /man /uni
/11 YG�
ORW: yes / no PNA es / no Crit. Hab. yes / no Closest Maj. Wtr. Body - Y _ -- / -----
C'fiYb/ �''� FIB/ �r t.,lL ti+—�l lac 7t v
Type of Project/ Activity l �nl� `4✓
(Scale:
Pier (dock) length _
Platform(s)____
Finger pier{s)_
Groin length
number _
Bulkhead/KPr�fength
avg dis"fance offshore L
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing '
Other
Shoreline Length -'- 00
SAM not sure
yes
Sandbags: not sure
yes
Moratorium: n/a
yes
Jno
Photos:
yes -
Waiver Attached:
yes
A building permit may be required
Notes/ Special Conditions
,PIL
EI-See note on back regarding River Basin rules.
4Z
et—
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Age or plica�rinteN��e Permit Office sSignature