37990_SMITH, MIKE_20050429 (2)

CAMA / ❑ DREDGE & FILL
6GENERAL PERMIT
Previous permit #
•New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by thg State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC (a
0 Rules attached.
Applicant -dame 0_x4F_ rP
Address t :=��� �+ r_t._ i
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City 77 i', 4, S, �. ..� State +�f i. ZIP 2 :3
Phone # ( ) Fax # ( )
Authorized Agent A � j" i1 � 0 i1
Affected ❑ CW SEW 'CR-TA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no... PNA Des -no Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision ,'; �i ..✓ : :� _
City ' :,...;: _ ;< .4 ZIP
Phone # O River Basin 'e'1 �.
Adj. Wtr. Body (nat-) man /unkn)
Closest Maj. Wtr. Body `V L`,/ v _-
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Type of Project/ Activity - ..'.; < <.
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(Scale:
Pier (dock) length
Platform(s)........._
Finger pier(s)
Groin length-
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel 1
1
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1
1
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cubic yards
Boat ramp
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Boathouse/ Boatlift) ! Z. Y J
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Beach Bulldozing
Other
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1 f
Shoreline Length
_� -- i
SAV: not sur� yes no _
Sandbags: not sure yes
Moratorium: n a yes •un.,. , _ -
Photos. yes -n� - j—
Waiver Attached: yes ,ncb '— --
A building permit maybe required by: !y. t-.o�
Notes/ Special Conditions
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❑ See note
on
back
regarding
River
Basin
rules.
?o, f "
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit*"
Pe mitOfficer'sSignatul
Issuing Date Expiration Date
Application Fee(s) ~Check # Local Planning Jurisdiction t Rover File Name