41163_GUAY, DAVID_20050328 (2)

MAR-28-2005 11:27 FROM:DICK LEWIS STATE FAR 12527264419 T0:16173574604 P:2
CAMA / D DREDGrz & FILL N© 41163
'GENERAL PrERMIT Previous permit#' -' C
L'New C]Modlfication ❑Complete Reissue FlPartial Reissue Date previous permit Essund_
As authorized by the State of North Carolina, Department of Finvironment and Natural Resources
and the Coastal Resources Commission In an area of environmental concern pursuant to 15A NCAC —%..
Applicant Name. �— n !J►tule9aca,Ghed.
� �/ � �'Q Project Location: County a- e_r e-;�- �p .
Address—E Street Address/ -State Road/ I.-ot #(s) , r-
City CB-L. Lo �.d . -- state
. GL zip
-- /�
Phone # (%f�)3.14�Fax # Subdivision­­.l7/�2 1 r6 /xJv
Authorized Agent V 1P
_ ..._... ��e� ---_u---.... City _._ —._. _ z1P
Affected W ESN A1FTA J ES I 1 PTS Phone 'i# (_) _ River Basin �kAi
110F.A ❑ HHF ❑ fH 1-1 UBA I I N/A h
AEC(s); Adj. Wtr. Body. // _ ' L S �!e� at an unknn
i 1 PWS; 0FC: _
PNA
aRW: yes / 0 yes / no Crit. Hab, yes / no
Closest Mal. Wtr. Body �d uG�P_u•t!4�
Type of Project/ Activity _ _ �, k Z Z�
�2 �o e G �� 5 . (Scale: ),
Pier (dock) length
Finger plor(s) _
' i
Cie -
Groin length ' I -
number --' _ -- -- — - - - -
RtAlkhr,ad/ R! re h " — I
Riprip IonRt ._ __
nvR distance offshore-
n-maz disLInce offshore-
SnAln, channal-
y�
��-I cublc ynrd : .
Boat ramp �I _
.. 1. �.' ---
i
Boathous oatlif-
_ ..
Boach BuildozlnA
Other.,----- i � I � i -
Lt
Shoreline Len
Sit
SAY, not sure yea
_ lSandbags: not sure yes - - -
Moratorium:
n/A yes � i- + � I 1 ,. I t _ I ,
Photos: yea -
Walver Attached: Y
A building permit may be required by; 5-1 -Y'e'- rw d b ❑ See note onl back regRrding River Basin rules.
Noces/ Special Conditions 00C4 ,I U'j H
! A, )z <�O 4?,1/a 4v e'ce�
pplicnn�r-ln�N�� .. .
Siynitire ' * Please read compllance statement oh back of permlt "*
Application Fee(s) Chock #
IssulnPpate _. ._,. •Fxpfratbnlaarn
Local Planning jurisdiction • „ . Mvor Flle Game

DAVID B. GUAY , - 5-13/110 2855
PATRICIA J. GUAY 0010407572
SPRING �AT
C DS
CONCORD,, MA 01742 J 7
(f A rn A
)THE OR10A Of
cG DOERS 8
�7 Flebt c>
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81358 Federal Street office
M0 &nloaW -
4 02110
IVY
1:0311000L318I: 00L04 075721" M55