63422_pier_20191129

A'7A-,
AMA 0 DREDGE-& FILL', __F I 71F, No'. 72
PERMI
GENERAL , : T Previous per
6\11,-`­ .77
Reissue, -El Partial -Reissue Date previous permit issued,
El Piet
°As
New Modification Complete
-8f North -Carolina, Departm int of Environmental Quality-
lautho'rized:b State
e.
y the
n p
C i area envirppmental AC
and'the Coastal Resources Pmm1ss1qP 1�,al f concer, pursuant to 15A NC
A 0/'/1 ulesattdched!
`Applicant Name Project 1_6cation: County�_, r-
ress' Street Address/ State Road/. Lot #(s
. I Ze &-/, ,e— - Add ;!5:3>rl�
41
Y" 644,� /_4 State_-ez a-cz_ 1 P.'X,�2-
Phon6e Subdivision C,
Authorized Agent%TdCity.% 'ZIPL-Q-1
'River,Basih A�-
�� ES ❑FTS Phone
5 DCW, Ew-E] El
Aff6cted',
El 0EA, F-1 HHF 0 1H El UBA 0 N/A Adj. Wtr. Body ari'iunkn),'
AEC(s):` m
Ell PWS:
Clos
est Maj. Wtr. Body
-s t-A ze4-
ORW: yes 0 PNA 'yes
�i 6, Kim 11 M 1A
M. ME
ME
MEN
MEMENEWORM
11
Shorieme Length Ajo
SAV- not sure yes onog
Moratorium: n/a yei K2
79
Photos: yes
Waiver Attached: yes.6n
I_ 'A building 0'ritmay.be.'required by:
'.,,m
Note Local. Planning jurisdiction
Notes/ Special Conditions
7.�/X, 4�2
Agent' Appli or. I yPri ted Name ­
`Signat6rd' Please read compliant. statement on back of permit
hXz­
-Application F eks), Check#
See 'note on back regarding - , River Basin 'rules..
" I \ I/,- I — -: ? //, I
PermitofficepWrinlo-Nam�c
Signature
'Isuing Date Ex$iration Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: t�,�//fin/O�`�`���
Date: �� �p��/�2at l
General Permit #: 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.nccoastaimanagement.net revised:02/03/10

Authorized Agent Consent Agreement
, l �ln i �1 � of Cj dV�J hereby authorize ( r�(,� to act on
(Property Owner)
(Authorized Agent)
my behalf in obtaining CAMA permits for the location listed below. This agency
authorization is limited to the specific activities described above.,
Property Address:
-n 1 017-) PtW (, c C o BC 4 2� a� 5 T—
Property Owner's. Mailingr.Address and Phone Number:.
Property Owner's. Signature:
Authorized Agent Signature:
Date:
It g-
Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09