45101_GILLIKIN, AL CARL_20060330 (3)

cCC
JC-,A►MA / ❑ DREDGE & FILL
GENE L P'ERMIT-!
Modification ❑Complete Reissue
❑Partial Reissue
Previous permit #
New
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
�.. F
LIVJ Rules attached.
`
Applicant Name p 1 ' -, ' j; ,
Project Location:
County j i-A Q
Address, . i i=•?-,. , > Ti
Street Address/ State
Road/ Lot #(s)
City i j ,' i. } i State' t ZIP
Phone # Fax # ( }
Subdivision
Authorized Agent ^*^
City
ZIP
Affected ❑ Cw I7`EW (TA ❑ ES ❑ PITS
14
o Phone # ()
River Basin
❑ OEA. ❑ HHF ❑ IH ElUBA ❑ N/A
AEC(s):
Adj. Wtr. Body
.,
( ,; :; rt;Lman /unkn)
� �
❑ PWS: ❑FC:
_.
ORW: / yes l no PNA yes / o Crit. Hab.
i
yes / no Closest Maj. Wtr. Body— �
Type of Project/ Activity 1 '; , ;..
Pier dock len hi C
Platf
Fing
Groi
Bulk
Basir
Boat
Boat
Beac
OthE
Shor
SAV.
Sand
Mor;
Phot
Wain
(Scale: ` )
IEEE
1'
ONE
OMEN
MMMMWM
0
ONE
ilm
EM
EVEN
OMEN
iMEN
MEMO
y
SEE
OMEN
MEMMMEM
ME
MMMEMMEI
MEN
No
A building permit maybe required by:
i
Notes/ Special Conditions
IL
7 A - i—
(rcd t
Agent or Applicant Printed Name W,APR 4 - 2006
Signature Please read compliance statemeM u .,, c'
❑ See note on back regarding River Basin rules.
Officer's nature
to
t
xpiration Date