43174_FORREST, TERRY & PAT_20051010 (2)

�AnnA DREDGEFiLa a(�AC�� 1\T° 43174
N ERAL. PERMIT
Previous permit #
C_ New ]Modification EJComplete 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 7
CI ules attached.
Applicant Name -_ tyPro ect Location: Coun
-
Address2._5CO3 1k" T> -__ Street Address/ State Road/ Lot # s LOT
City D S jQrp---- State-&—ZIP�,7-sue--
Phone # ( ) 3S_ Fax # (q )7—Z1-V R/7 Subdivision
Authorized Agent City __(LQ(,� �55� _____ ZIP_
Affected O CW 5a W lc/PTA 51,`" [1 PTS Phone # (�J�Z) W241-1 River Basin _�V�lfefit. Q�
AEC s : ❑ OEA O HHF ❑ IH 1-1UBA Ll N/A
Adj. Wtr. Body nat man unkn
❑ PWS: ❑FC:
ORW: �/ no PNA yes //?-�) Crit. Hab. yes / no Closest Maj. Wtr. Body —
Type of Project/ Activity
in
Pier (dock) length
Platform(s)�j�1c�
Finger pier(s)
Groin length
number �
ulkhead Riprap length�S �� )
avg distance offshore
{�
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse oatlift
(Scale: / f )
Beach Bulldozing _ f / " / / / / /
Other �E; PAGG° lit/"
/ -
Shoreline Length #42L w X4
SAM not sure yes
Sandbags: not sure yes
Moratorium: n/a yes ho 1 p ISTt NS i�dUS
Photos: � no {/ L 1� 0 a r Y�
Waiver Attached: yes
A building permit may be required by: L—�P1LA(Z (S (Y ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions [ 4)(2 L-IT-UMAuC9 (D �Qc /( /,e{+�✓�S / �%&'21, 49 Ile 44�6d Oja
S. Q4—Li7,,-,1;2 - o 15i2ai o
(9 4LIRn'J /44 4r ho 12PPIle, 0 W <2, ^ ceAnlcAnt) C
O rt— i
Agent or Applicant Printed Name
7 c of es Fes,"
Signature Please read compliance statement on back of permit
'4100 3!970
Application Fee(s) Check #
Permit
1011012�5 I &kead ; 11_ty
Issuing Date 1 t.Expiration Date
Local Planning Jurisdiction Rover File Name

DIVISION OF COASTAL MANAGEMENT
OFFICE:
TELEPHONE:
FROM:
4 0 0
NCDENR
NORTH CAROB NA UCPARTNCNT Oi
`.4V!RONHLNT AND NATURAL RE59URCCS
FAX:
Morehead City Office
400 Commerce Avenue
Morehead City, NC 28557-3421
Voice: [phone]
FAX: [phone]
DATE SENT: iphwlor
TOTAL PAGES INCLUDING COVER SHEET
0

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