43507_FOWLER, ROBERT_20051109 (4)

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�' EI ��,��-,� i ���� � � Previoti i�:.i rnit # — _-
- 1 ew ,[2igodification [ Complete Reissue ❑Partial Reissue Date previous permit issued_
As authorized by the State of North Carolina, Department of Environment and Natural Resources t �
and the Coastal Resources Co imission in an area of env'ronn-iental concern pursuant to 15A NCAC_ �� � `'_
6-) 1 - -.,, ❑Rules attached.
Applicant Name--- `_— elr _ v Ix" _� _ Projec:i.'. ,cation: County-----Q-._-----`—
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Address �� L, "C-'vltil C :car lee, '`aA — Street Adress/ State Road/ Lot # s
State�C ZIF'rr2a, 6_ --- -- — P n--- Zc ,,,t i aKC✓ 1 At -
Phone /t (.) 6,YJFax # ()— - Subdivision— _ --- - _ ----
Authorized Agent
Affected CW 1A ElES ❑ PTS
AEC(s). O OEA [11HNF ❑ IN ❑ UBA ❑ N/A
❑ PWS:__ DFC: _
ORW: yes / no ) `PNA yes /lKo ) Crit. Hab. yes / no
Type of Project/ Activity / 01a it
City--- C7 `4o,,------ �- --- ZIP
Phone # (.__) _ River Basin ` .Ai
Adj. Wtr. Body %o Cirir oe L _ na —[unkn)
1 I V E
Closest Maj. Wtr. Body L-e f YL
f
/ o o ,;j , A, of(� e/
I Q
(Scale: A /—t-S
)
Pier (dock) length_�_
_
Platform(s)
Finger
{
/'
3 x /S
C4 j
pier(s)
_ - 1. -
tL
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards I
I
I
Boat ramp-
( - -
Boathouse/ Boatlift
--- -
r
Beach Bulldozing
-, --- r - -- - - -
-
Other
i
Shoreline Length
(-
SAM notsure yes no
Sandbags: not sure yes
Moratorium: n/a yes o
I r
Photos: yes
Waiver Attached: yes n --- - - --
A building permit may be required by:
'- _ _-w _- ~�•-------
C Ar-Il of e�- CK,
- --- - --- - ----- - ---- - - _
❑ See note on back regarding River Basin rules.
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Notes/ Special Conditions rloeer 12irl- t l
2X1I I-- I LA tA
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
1 CCU � �
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Is uingDat Expi ti nDDatg a
Loc i nine lurisdiaion Rover File Name