Piner, Faith Ann

[�]CAMA / ❑ DREDGE & FILL
^`
GENERAL PERMIT
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
N2 70419
A B C � D
Previous permit #
Date previous permit issued
A licant Name' 1 � - ' " 1 Ael— Project Location: County
❑ Rules attached.
6
PP
rx3xxStreet Address/ State Road/ Lot #(s)Address
City 01410� � , , : �?
�4elj 6
"" State ZIP
�' 7/`VSubdivision y.
• !LIE -
Mail # (�. ) E Mail
Authorized Agent
❑ CW
Affected El OEA
AEC(s):
❑ PWS:
ORW: yes I no
EW ❑ PTA ❑ ES ❑ PTS
HHF ❑ IH ❑ UBA ❑ N/A
PNA yes / no
City e e ,. .,� « ?.- ZIP a< 0
Phone # ( ) ,., River Basin
gnat fman %unkn)
Adj. Wtr. Body. —
Closest Maj. Wtr. Body �-
f Pro
Type o Project/ � / Activity
(Scale: )
Pier ((
Fixed
Floatii
Finger
Groin
Bulkh
Basin,
Boat
Boat
Beacl
Othe
Shore
SAV,
More
Phot
Waiv
A building permit may be required by. '
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
C4 i
"I 4Application Fee(s) . f Check #
See note on back regarding River Basin rules.
_ r
dam- �` ...� , �°',►�'?
i
Permit Officer's Printed Name:-....�
Signature..
Issuing bate Expi ation Date