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❑CAMA / ❑ DREDGE & FILL
'GENERAL PERMIT e
Previous permit #
❑New ❑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 t
_ O Rules attached.
Applicant Name Joel Project Location: County T
Address , C c rJr P I r+y ; z 4✓
City ✓tr State A ZIP 1$424
-a
Phone#Fax#( )
Authorized Agent
Affected
Q cW
AEC(s):
❑ OEA
❑ PWS:
ORW:
yes / rio.
oroe
Pd EW N3 PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes./ no Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
city i, �� r6. ar, �' ZIP
Phone # `
( ) River Basin 04 • � r-dic
Adj. Wtr. Body ! `� • J ('Pek (nat /man /unkn)
Closest Maj. Wtr. Body %`jl .' , � P V-
Type of Project/ Activity
qq r'
(Scale'
Pier (dock) length
Platform(s) f 7 --
Finger pier(s)
Groin length
number ----- C
Bulkhead/ Riprap length--
avgdistance offshore
max distance offshore -
f
Basin, channel
cubic yardsill 7
—
Boat ramp _ _ 1 —� _ r Z 4-t
rW� I
K :-..
Boathouse/ Boatlift
Beach Bulldozing _ I
Other
Shoreline Length
— — - -- 1
SAM not sure yes no,
Sandbags: not sure yes -
- — —
— —
Moratorium: n/a yes no, ' I 7 I —
Photos: yes not
i jj
I
Waiver Attached: re`e} no ---__.. ------- - --- —_ _.----_-_--- t-------- -� ` �!
A building permit may be required by: (�' , ' t 1 /� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
P « Nr N'v/• v.cy(f "~-c "'"+,"� ��!—'G� �. �rCi�'Yf
i
Agent or Applicant Printed Name
Signature +sa Please read compliance statement on back of
Application Fee(s) Check #
AJ
Permit Officer's Signature
Issuing Date Expiration Date
:2tt GrJ
Local Planning jurisdiction Rover File Name