63204_boatlift, platform_20191012

,CAMA,/ ❑DREDGE '& FILL ��� LGj� L
'GENERAL
N®. '72494 �• c;. _D=
Previous permit #
IXNew. ElModificatiori ❑Complete Reissue OPartial Reissue
.e ,
Date previous permit issued
As authorized by the State of North Carolina; Department of Environmental Quality
'an
and the•Coastal Resources,Commission inarea of,environmental`concern pursdant to 15A NCAC-
/ LRrrI es a ched.
Applicant Name • /—� Y Project Location:
County
- .Address
/ d , r Street Address/ State Roa %Lot #(s)�
City C State ZIP ' ��
/ % /.Gif�GY1,
Subdivision
Phone) ^. E-Mail. %�
�.�i" /7C
Authorized Agent' (jam//�(�L' l.�r �l�► City'
r
Affected Cw . - : XEW C PTA• OES ElPTS' Phone # ( )
El OEA ElHHF ❑ IH ❑ UBA ❑ N/A
'.
River Basin
�r %�/ '
AEC(s): Adj. Wtr. Body
% /w S , nat man unkn
❑ PWS: ,
ORW: yes / o PNA yes / �' Closest Maj. Win Body /
00 G �`� -�
MEN
■■■■■■■■■■■
I
r
C`
Agent r App ican , ri
y ` Signature ; Pleas(
Application Fee(s)
Name
compliance statement on back of permit I
Check #

NC Division of Coastal M to Habitat Impact Computer Sheet
Applicant:
Date: �� tGk�l
General Permit #:oZ�t`"/7
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
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.nccoastalmana-gement.net -revised:02/03/10

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