63150_Propose to replace exsisting 8 x 282 pier and existing 8 x 58 T- Head damaged by Hurrican Florence_20180925

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p� GENERAL =PERMIT Gig_ Ate; :G D
f° 4Previous,permit
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New Modification ❑Complete Reissue -❑Partial Reissue . Date previous perniit:issued WZ
As authorized by the State of North Carolina-, Department of Environmental Quality
and the Coastal'Resodrees Commission in an area of environmental concern pursuant to 15A NCAC
Rules ttachec_
l} '� Applicant Name Project Location: County
Address Street Add ess/ State Road/ Lot #(s) i n
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City �f' /� r State/6 ZIP - K94��
Phone #�(�_-,-
E-Mail Subdivision v� r
Authorised Agent_ %)' r 42p P-rr / e! City ZIP
Affected ` El ❑ EW lv� PTA ❑ ES El Phone # ( ) River Bali
❑ OEA ❑ HHF . ElIH El ❑ N/A `
AEC(s):. Adj. Wtr. Body \ nat Zean unkn
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Pr:pj*e'ct/ Activity •
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■■■■■■■■■■■■■■■■■■■e■■■■■e■■■■■■■■■■■e■e
... ..ASee note on back regarding River Basin rules..
_Agent or -Applicant d Nam
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Signatur Please read compliiance st:
Application Fees)
CG
ieyn back of permit"
Check #
Signature
Issuing Date
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Authorized Agent Consent Agreement
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I k(/Gr/aehl t ars- -aC--hereby authorize An to act on
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(Property Owner)
(Authorized Agent)
my behalf in obtaining CAIVIA permits for the location listed below. This agency
authorization is limited to the specific activities described above.
Property Address:
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Property Owner's Mailing --Address and Phone Number:.
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Property Owner's Signature:
Authorized Agent Signature: _
Date:
Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09

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NC Division of Coastal IM Habitat Impact Computer Sheet
Applicant: /�/l.Z-� (v ,®�I
zz
Date:
General Permit #:��
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/or temp
impact amount)
TOTAL Feet-
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
a
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10