40168_NC DOT_20041207

1 GAMA"-'k R-kOGV-4 FILL ;�` ID
GENERAL. PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Dat j 'Ie 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 I SA NCAC t✓A 71t+
JY Rules attached.
Applicant Name_ Project Location: County (340 r d
Address Q �{j f] �aU� i i. jl� Street Address/ State Road/ Lot #(s) j pits
City `"( .State ZIP `5n l2-Z ��"rn k-
Phone # (25N nt Fax # (_) Subdivision
Authorized Agent City 1-t. ZIP ()
❑ CW ❑ EW iPTA ❑ ES ❑ PTS Phone # ( ) River Basin (`b� �,T iI
Affected ❑ OEA ❑ HHF ❑ IH ❑ USA El N/A
AEC(s): Adj. Wtr. Body a !,� nat man unkn
❑ PWS: ❑FC: Wg�' - - s,� � j'ti (. w'lkk-
oRW: ves / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body ��� " '-Tut �ewig
Type of Project/ Activity
Pier, (dock) length
Pfatform(s).
Finger pler(s)
_
Groin length
number-"
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
j
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Qther4 -sll.t& -7 ,_
Re- r': we E- � �-
i.,l ..—I'%/urIU
Ilvre—P
Shoreline Length _ !
SAV: notsure yes rrc� I
Sandbags: not sure yes e0
n/a yes r
Moratorium: COIN -
Photos: no——!—!
Waiver Attached: yes rri
A building permit may be required by: rat e{ t l me %l �irP/.r.�'� ❑ See note on b lk i
Notes/Special Conditions' WO-tA&r) I,M.t�d12r A1DT- `fU ew6:� �-�� z) A lo nU
(Scale: i
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eyn
L'.�YMalC42t:t�
DIi►tly, c�f�
ig River Basin rules.
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c) rLvd lift P[,!HtlJh-Il,'- �:L C'!J `Irtt 1.VhrJr.lit ZrJGIrJ� n. i /� 1
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit **
� /' •ram [,�-- �G•--� � �--3 —
Permit Officer's Signature
Issuing Date ' Y ExpVationDate
(� , T �1l CfL� iIi'