58790_BARKER, MARION JEAN_20120524 (2)

❑CAMA / El DREDGE &FILL V -. GENERAL PERMIT Previous permit # C y f J
ONew odificatio El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources t�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
_ ARules attached.
Applicant Name ' ��(}� �' IM Project Location: County
Address' 9 Street Address/ State Road/ Lot #(s)
City Sill State ZIP�9
Phone #9 i Fax # O Subdivision
Authorized Agent City /+ i /' ZIP r `'
E�
Affected ❑ cw ElEw ❑PTA ❑ ES ❑ PTS Phone # River Basin s
�l?y,, �..;t
AEC s : ❑ OEA ElHHF p IH ElUBA ❑ N/A Ad'. Wtr. Bod PAS i�31 t 7)4j k I
Y - Gnat'/man /unkn)
❑ li ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes /,'no
Closest Maj. Wtr. Body
Type of Project/ Activity
rs ,
n (Scale: 1� )
Pier (dock) length a; -;i y: ! 1 1 LG1.
Plata
Fing
Groi
Bulk
Basii
Boat
Boat
Beac
Oth(
Shor
SAV:
Sand
Mon
Phot
wan
Prni
-- —
®■�tLi■■�
_
■il■L'
-i length
iZ;)�'�■t■■�
■
�
■
OMEN
EIN
number
.
■■■■■■■
■■■fay=
�■■■■■
MEMO
..
s��irli�■■■■■■
A�
■■
■�
f
���r
r`�Flirl��i■■
Nwow.
U
IAFAMM
■■
mMIr�j
■
■■■■!u
M
■■■■■
■■■■■
I
n
NOWMINE
--h-
u■
■■
era■■■
■■■■
■■■■■
0
A building permit may be required by: 1 i;/ ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printe�ame
Signature Please read compliance statement on back of permit
Permit Officer's
Issuing Date
Application Feels)
Check #
c Aw :
Local Planning Jurisdiction Rover File Name