41756_PHILLIPS, JOHN_20050524

E CAMA / DREDGE & FILL
GENERAL PERMIT
,xCNew ❑Modification Complete Reissue
As authorized by the State of North Carolina, Department f Ei
and the Coastal Resources Commission in an area of envi onme
Applicant Name --' F `
Address—
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City % t '' �''� i State IP
Phone # `- 1 / Fax # ()
Authorized Agent
Affected D Cw ElEW y�PTA ❑ ES ElPTS
A D OEA [IHHF ElIH ElUBA ❑ NIA
- PWS: ❑FC:
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Previous permit #
❑Partial Reissue Date previous per issued
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ZZ:__1,
iron t and Natural Resources
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pursuant to I SA NCAC 'f `
"Rules attached.
Project Location: County _—
ORW: yes /; no PNA yes /,"no Crit. Hab. yes / no
Type of Project/ Activity
Street Address/ State Road/ Lot #(s)
Subdivision
City _ ZIP
Phone # O River Basin
Adj. Wtr. Body ' _a - (r'Iay/man /unkn)
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('Ir cr Mai Wrr R-4v
Pier (dock) length
_ - -- --.--- - - -
Platform(s)
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Finger pier(s)
Groin
I
----------��-
number
---
.- --
Bulkhead/ Riprap length
avg distance offshore
-
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathous.( oatlifv
Beach Bulldozing
Other
I
Shoreline Length
i
SAM not sure yes (no: -- - --- — --- -- -
Sandbags: not sure yes no
Moratorium: j
Moratorium: n/a yes �nq
Photos: yes
Waiver Attached: �es no - -- —'
y�
r
A building permit may be required by: 1 '
Notes/ Special Conditions
AApplicant Printed Name
Signature "Please read compliance statement on back of permit"
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(Scale:
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❑ See note on back regarding River Basin rules.
Permit'Officer'sSignature
Issuinglssuing Datd Expiration Date
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Local PlanningJurisdiction Rover File Name