59911_NC DOT_20120801

RIrCE�VED
Y.CAMA / C DREDGE &FILL 1'1 O.A59911
--. GE v L PERMIT Nov `� ��?Previous permit# ;1,; f%%
Clew Modification ❑Complete Reissue El Partial Reissue Date previous permit issued /
As authorized by he State of North Carolina, Department of Environment and Natural 1�5eR4ilpft CIT -�, ✓
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC % %4 7
❑ Rules attached.
Applicant Name Project Location: County_
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Address / % 1 Jf %i% Street Address/ State Road/ Lot #(s) �j % /h ,�,��3�,
CiState&—'4 ZIP
Phone # Fax # (�5Z)yR. - g7 Subdivision
Authorized Agent CityZIP��
Affected ❑ Cw ❑ EW KPTA ❑ ES [ KOTS Phone # (�) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): ❑ PWS: ❑FC: Adj. Wtr. Body
ORW: yes / <hDo PNA yes /9 Crit.Hab. yes / no
Closest Maj. Wtr. Body �4:i.4
Type of Project/ Activity
Pier (dock) length
Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
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—
Other
/V,-- r-�"
a !f ex
Shoreline Len- o
SAV: not sure
yes
Sandbags: not sure
yes o
-"
Moratorium: n/a
yes
Photos:
es no
Waiver Attached:
es
- - - — 1 CA
—
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A building permit may be required by:y/ 1!W/ai)- Al I (jU419lt ElSee note on back regarding River Basin rules.
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Notes/ Special Conditions f %% Q/,p/ />li /�Jw i/ert / 111/� r}5 h11Gi�� bt-,, -d
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Agent or Applicar Pr tensPr tens d Name
f!L; fr f�•' i 1Y
Sign ture ** Please re,,ad�compliance statement on back of permit
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Application Fee(s) Check #
(Scale: /V//�
Issuing Dat Expiration Date
Local fianningjurisdiction Rover Pile Name