General Permits (7622)

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GENERAL
PERMIT Previous permit
EINew DModification 7jComplete Reissue ElPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
concern pursuant to 15A NCAC
and the Coastal Resources Commission
in an area of environmental E:j, es attached.
Applicant Name
Project Location: County
0."
A 1 0 0_11 Street Address/ State Road/ Lot #(s
Address
r"Ali
City
State_VZl
Phon # I a
q
Fax # Subdivision
e
City
Authorized Agent
0 PTA OPTS Phone # Y River Basin!.
Affected
0 OEA 0 HHIF
0 1H 0 UBA F-1 N/A Adj. Wtr. Bod Gt /man
-Y
/unkn)
AEC(s)-. El PWS:-
0 FC;
Closest Maj. �tr. Body
ORW: yes /(no\.% PNA
yes o Crit.Halb. yes no
Type of Project/ Activity 1- "-! T__J 1Ire
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
_7T_
/"Bulkhea� hiprap length
avg distance offshore
max distance offshore,4/,
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift—
Beach Bulldozing
Other _J I
T.
Shoreline Length
SAV: not sure yes n
Sandbags: not sure yes no
-yes 1_ha
Moratorium: n1a
Photos: yes
Waiver Attached: yes no
See note on back regarding River Basin rules.
A building permit may be required by:
+
Notes/ Special Conditions
12
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Ri�ePszgignoa�
Permit Officer's tukre
Agent or Applicanio Printed Narge
Issuing ate
hXp 66—nl)a e
Signature a
ad compliance statement on back of permit
I - 1 9 6 , ­Z:" 10
);
Please re
1�.v6r File Name
Local Planninijurisdiction
Application Fee(s) Check#