63071_Authorized 16' x 16' Platform 20' x 4' & 23' x 4' Platform & 48' x 6 pier_20180905

-AMA/ ❑DREDGE &,.FILL
NO. �%2433.
PERMIT
vious-Per.
permit
El Modification ' ❑Complete Reissue El Partial Reissue Qate,'previous, permit -issued
_
'.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
Applicant Name -COAR-LE, -S L QAX
ules attachFd.
Project Location: County_��$ }�l �. �1�/-
Address- �ZO's r, -] lk
Street Address/ State Road/ Lot #(s) �t�0 PAS 66� t "Aid'%,
'City1`'/1 �Ay/4Ll State (','ZIP Z79711
Phone # �70 5 E-Mail ,
Subdivision' I� rF6I"- GAY
'
Authorized ent` :
+.
Ci ty �n �� ZIP �'-/ D ;
Affected El CW 'EW.�TA' ❑ ES ❑ PTS
Phone # River Basin .
( ) F/I SGjU6%�„
-`
❑ OEA ❑ HHF ❑ N ❑ UBA ❑ N/A
-AEC(s):
Adj. Wtr. Body 11/ 1 MARLI Sb" nat /man /unkn)
❑ PWS:
ORW: ,yes / no PNA yes / no
n Closest Maj. Wtr. Body :J Lf?E!4A�� F SOG+nJ�
i .,r
Pier (dock) length
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Groin length
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Basin, channel
Boat ramp
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BUNIONS
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' Agent or Applicant P irf ed Name'
..
`' Signature P e e read compliance sta
Application Fee(s)
i� OAF,
Permit Officer's Printed
%Name
�
;nt on back of permit Signature
TA.-J z�l�
Check# Issuing Date Expiration Date

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Applicant:
Date: �-
General Permit #:1. 2 3
Describe -below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and%r temp
impact amount)
TOTAL Feet
(Appl(ed for:
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or -
temp impact
amount)
�' j,jt�►
Dredge ❑ Fill ❑ Both ❑ Other
(T'
FT?
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ " Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill, ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other [I --
Dredge ❑. Fill ❑ . Both ❑ Other ❑
Dredge ❑, Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ .Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑