NCDOT (2)

C�'CAMA / &DREDGE & FILL F ILE
COPY Na 67491 A f O
GENERAL PERMIT
Previous permit#
Blew ElModification ❑Complete Reissue OPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources j� `^7 cc
� + /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
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Applicant Name !r "`` __..._._....._
attached.
Project Location: County �''
Address_._.. f •- C6,.1 %f
Street Address/ State Road/ Lot #(s)_ f.....7 dt
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Ciry State I L. ZIP `T ��
attpl"Kir�:�P% i`✓. r%e� �i.r �b « S",h" 06
Phone # !`j"as �,.hr� r�Ac.='l
)_. E-Mail .
Subdlion
Authorized Agent 4 aIAr,Vi
Cijr ....._.l _ , -
ZIP �--
© cw i�V RftA Igd LiPTS
Affected
Phone # {) _ River Basin
O OEA 0 HHF 0 IH ❑ UBA 0 N/A
AEC(s):
� .
Adj. Wtr. Body_��.._ o �"�- .,�' `°^'� gnat [�n�an'%/unkn)
0 Pws•
,
ORW yes `t,n PNA yes /
Closest Maj. WinBody
Type of Project/ Activity
Beach Bulldozing
Other ..
Shoreline Length 3
SAV: not sure yes no
Moratorium: n/a yes
Photos: no
Waiver Attached: yes
A building permit may be required by: f ` z "" ❑ See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Special
Notes/ !s
P� Conditions {� t
J�JdAVI�
Agent or Applicant mted Name
Signatur(te'� **' r mpliance
{ statement on back of permit **
Application Fee(s) Check #
Pern►it4fficer' Printed Name
Signature
Issuing Date
Expiration Date