41707_SMITH, ROBERT_20050512

'AMA / DREDGE & FILL pr CQU �>,C� ��c1 ���(� N°_..— 41'707--
ENE_RAL PERMIT J
Previous permit #
ew '` Modification —jComplete Reissue ❑Partial Reissue Date previous permit issued
As aut orized by the State of North Carolina, Department of Environment and Natural Resources ti,/, F Gl
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC (f j� (•'
e` � Rules attached.
Applicant Name o� rr-L J(0`` Project Location: Coin
Address 3�p �Gt CC_t 4 Street Address/ State Road/ Lot #(s)
City State ZIP a-7S-/F-
Phone # 09) Fax (_) Subdivision
Aut - e+�t-- " =�/`. City �� Pia ly' ZIP 2�r5 j
Affected 0 CW � ��TA Ci ES � PTS
AEC(s5: OEA ❑ HHF ❑ IH - UBA 0 N/A
O PWS: ❑ FC:
ORW: yesV no PNA
Type of Project/ Activity _
yes no Crit. Hab. yes / no
Phone # ( ) River Basin�%�
Adj. Wtr. Body f3o- ---e ✓yG,rr./ nat /man /unkn)
Closest Maj. Wtr. Body 6 dS `` ( Jc "'"--f
QC; , 1-16 ' /— / &, 0( L', i C 01 } f c . -7 , 10X Z " &,-4" J1
Pier (dock) length'
Platform(s) �U 1 X 2 o f L S)i e �v n •l
Finger pier(s)
Groin length i
number �-
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp _
_ r
oathous Boatlift zc'
Beach Bulldozing
Other
Shoreline Length /-5
SAV: not sure yes (no',,Sandbags: not sure yes , f
Moratorium: n/a yes 0/
Photos: yes of
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
A�fe t or p+ aar Print � N
Signature - Please read pliance tement on back of permit"
lGv l-7YU
Application Fee(s) Check #
(Scale: Al )
L
_ See note on back regarding River Basin rules.
Per + fficer'sSignatu
Issuing date _ Expiration (Date
Local Planning Jurisdiction Rover File Name