45273_ANDERSON, RODNEY_20060511 (2)

DCANJIA / DREDGE & FILL
GENERAL PERMIT Previous permit#
L Nevr-iModification ❑Complete Reissud [-]Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources 1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
dy�e
les attached.
Applicant Name 0 P- &00-'1 Project Location: County �/9� f P(t4
Address (� �1}I��(-ee- y Street Address/ State Road/ Lott�#(s)
City_-_�,-- Ufrklq:: Q;rk StateZIP
Phone # i C1-7"�.e�Zi Z Fax # ( ) Subdivision
AuthorizedAgent City ZIP- /
CW ElEW- [I PTA ,ICES ElPTS Phone # ( ) River Basin j i+ DA(C-
Affected [ p
AEC(s): ❑ OEA ElHHF ❑ 1H El USA ❑ N/A Adj. Wtr. Body (4 JO Lt Xa)/man unkn
❑ PWS: ❑FC:
ORW: Ve / no PNA yes 2no Crit. Hab. yes / no Closest Maj. Wtr. Body IA.
Type of Project/ Activity
(Scale: )
Pier (dock) length - - - - - ---
Platform(s)
- T T
Finger pier(s)
Groin length -- — - — -- - - -
number - -- - --
L
1
r�lk�h.a,dRiprap length
distance offshore ,-
max distance offshore (J -AAI _�_
_ ..
I I
_
Basin, channel --
_ � I
- - -- -- ----- -
j
r - -
_ _ _ r �- --I- r
Boat ramp I _
cu is yards � I
- — - - - - -
Boathouse/ Boatlift � — - --
T - -- -
Beach Bulldozing
Other
- -
- I
Shoreline Length-
SAM not sure yes
yes
i_ L
Sandbags: not sure �-
g yes n
Moratorium: n/a
Photos: yes o ok,
i- T
Waiver Attached: yes
A building permit may be required by:
Notes/ Special Conditions
e 6,11J J
Agent orApplicant YPrinted Name
Signature `Z Please read 2omplr6ce statement on back of permit"
Ow �See inotp
et 1, A
on back regarding River Basin rules.
,J (44 k;J
AP
Pe ffi er's Si ature 4,
issuingDafe Ex irati n Date

Rodney V. Anderson Wachovia Bank, N.A.
300 Fairtree Drive Crown Banking
Severna Park, MD 21146
65-320 / 550
PAY TO THE NCDENR
ORDER OF
One Hundred and
NC Department of Environment &
National Resources
400 Commerce Avenue
Morehead City, NC 28557
MEMO New CAMAI Permit * 45273 �Z3
"'001420i►' I:05500320Ll:1010076622?9911n
1420
8/10/2006
$ **100.00