Farmer, Dave

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❑ CAMA / ❑DREDGE & FILL N2 70965 A
GENERAL PERMIT Previous permit #
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ;«,,,,fki y
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and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ice' 7 � "'.� � • `r�¢Hds'��1�i
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❑ Rules attached.
Applicant Name
Address I (^)�
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State_ ! ZIP
Phone # wo •','r E-Mail ;
Authorized Agent
ElCW D EW ❑ PTA El ES ElPTS
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes / no PNA yes / no
Type of Project/Activity y.
Proiect Location: County
I
x-
B C D
Street Address/ State Road/ Lot #(s) �` �: y Oil
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Subdivision
City_ ,
T: ZIP
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Phone # River Basin
Ad1' • . WtrBodyt "" ' nat /man /unkn
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Closest Maj. Wtr. Bo d y
Pier (dock) length _.
_ _ _ _......__....:.__ _. ...........W_ _ _ r
Fixed Platform(s) _PP
_ a
1
Floating Platform(s)
Finger pier(s)
r
.. ....... ......
I
Groin length t E
t
number
Bulkhead/ Riprap length
,.fie
-MOO z
avg distance offshore"
max distance offshore 3
3
Basin, channel` _
Boat ramp
(Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure
Moratorium: n/a
Photos:
Waiver Attached:
Y
A building permit may be required by.
( Note Local Planning Jurisdiction) r,
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Notes/ Special Conditionsi {y
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Agent or Applicant Printed Name Ji ,
Signature Please read compliance statement on back of permit
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Application Fee(s) Check #
(Scaler )
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7
See note on back regarding River Basin rules.
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Permit Officer's Printed Name
Signature~
Issuing Date Expiration Date