38365_FLYNN, BILL_20040521 (2)

GC� AMA / DREDGE & FILL NY 38365
ENERAL PERMIT
Previous permit #
lew Modification ❑Complete 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 / /1. 1�2M
�^ ❑ Rules attached.
Applicant Name < < I r 1YAJAI Project Location: County a4gerie %_
Address p-o' )C _ Street Address/ State Road/ Lot #(s
City ?Q l � State ZIP ��?`� 0, LL'?�
Phone # () 51{' Fax # () Subdivision - GCS s
Authorized Agent City I Re� Xzpl ZIP
Affected `J CW )eEW PTA DES L_ PTS Phone # ( Z5LRiver Basin
❑ OEA ElHHF 1H El UBA ❑ N/A
AEC(s): Adj. Wtr. Body _�5X40 e5zyan JunkJn
❑ PWS: ❑ FC:
ORW: (y�e,/ no PNA yes / o Crit. Hab. yes / no Closest Maj. Wtr. Body + Jo
Type of Project/ Activity % X /,Z • j Vk% C f_ -2, P,_ o270 Ir,4 —( / F( 4V EcA,�46_ &4 71'��.
n Scale: (
I
Pier (dock) length 1 /
Platform(s) ��(_ �I ViY�
i
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length AI CC 1� /fir
avg distance offshore ^l
max distance offshore
Basin, channel •i /-('��fi
cubic yards Y I 1 16_`
�X
Boat ramp
Boathouse
Beach Bulldozing
Other I �� SSE
s �= Q A.
C`
Shoreline Length
SAM not sure yes
Sandbags: not sure yes n 11' '( \ ,� ��✓
G4:
Moratorium: n/a ;es
n FL, V'V
/��1Q
Photos: no � �� vnu)��� l v;' t CT l( ,.�( tic✓)Waiver Attached: no �- / /
A building permit may be required by: Ir l ,'J o' ,�tii. 9(.�� �� 4 See note on back regarding River Basin rules.
Notes/ Special Conditions 0, Iti�� TCi 1'c�, r)[; i�IGGICf!ll=y lAk )4-•L [7
SiS `//)!) t «��%fir'_%4l
ZS15 C (N r 4116o, ^r�-, 1f �-V kL r <05r5/%/J✓/ ^�'Grv' GT 4 / r__/7--7 % -)f ,C ; eH-r
Agent or Applicant Printed Name
Signature * Please read compliance state ent on back of permit*
Application Fee(s) Check #
Permit
i
q1,7•//C
fA�� Cce c 5ct" XL5_2 ( c ? A
Local Planningjurisdiction Rover File Name

y APPENDIX K: Telephone Referral Form
DCM Telephone Referral Form
Date
t q 6,�
DCM Staff (initials)
Name of Caller (if needed) /
Area Called
Address(if needed for followup
Phone NO. -,J QJ ``[ ✓ —` `-"
a 5a -,2V/ / tl71 &,a
Nature of Question or Request
f>/
Referral Made to Caller Yes No
Referral Made to: DEM/FEMA DCM Field Office:y
Small Business Admin. Local Utility Red Cross
Other (Please note)
Other General Information Provided to Caller
Followup Needed? ✓ Yes No
Followup Assigned to:
Appendix K
1

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