33712_LANE JR, ANTHONY T_20030521 (2)

CAII�IA / ��DREDGE & FILL rk;,
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GENERAL PERMIT Previous permit#
>(New ❑Modification El 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
Rules attached.
Applicant Name Project Location: County D ''
Address /0 Street Address/ State Road/ Lot #(s)�
City State L ZIP_ _
Phone # ( ax # (_) Subdivision F o�c4 S �-- i�4� �['�—
Authorized Agent X4i ay A&I
n.CW ;]TW C)PTA UBS ❑ PTS
AEC(s):
Affected 00EA ❑ HHF ElIH ClUBA ElN/A
❑ PWS: ❑ FC:
ORW: yes no PNA yes / (fd-2 Crit. Hab. yes / r r—
Type of Project/ Activity t��' %� %IA L—KV61 I
MWIMM,
Phone # (
Adj. Wtr. B
Closest Ma
(Scale: )
Pier (dock) length
Platform(s) 20 -�J • >C
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n�ber
Bulkhead/ Riprap length
avg distance offshore
max distance offshore.
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
Shoreline Length
SAM not sure yes
Sandbags: not su yes no
Moratorium: n/ no
Photos: yes o
Waiver Attached: yes no
NIEMEN
ONE
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A building permit may be required by:
Notes/ Special Conditions
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Agent or App1' tt Printed
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Signature ** Please•read comp iance statement on back of perMo fnit�'
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ApplicationFee(s) Check# '4
❑ See note on back regarding River Basin rules.
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Issuing Date 1110000,Expiration Date
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Local PlanningJurisdiction Rove�Fil4f4ame