63420_pier, L-head_20181129

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GENERAL Date -previous perniliijs�u�d
pi�te-Reissue *,'E]Pa'
ificatidh - El Corn rtial. Reissue
As,authorized the Stke'61"North aro ina,�Del5artment of Environmental Quality
and the Coastal;Resources .Commission in an area of environmental concern pursuant to I SA NCAC
ules attached:_ Applicant Karne-= Project Location: County' " Y"r,
A ' 614 , Lot i�w
dd'ress% ',,R e_ 1^ e_- Street Address/ State Road/
A.
.
4�'Mzq ��- , , State ZIP 27
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iy_444k�ko —.
Phon
e #g e
Subdivision
CA'
K
Authorized Agent V4. "ZIP
g city
`0 C Ei, ES 0 T51 P 7,
El E F16k , -,Phone-#'.
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Affected,
El OEA- 0 HHP E11H -'-D,UBA El N/A.
AnDiman 16nkn)..
-.Adj. Wtr.,Bod 10t�zlt
A
E] PW S:
I ' I- Closest Maj. Wtr. Body-
-ORW: yes -/.no'- �ONX_ yesno
Type of PrActivityActivi 4-
(Scale:
Fixe
Float�
• Fi
Gngl ro
'Bulk
Basil
Boat
Boat
B6ac
.6tho
Shor
SAV
MoTorium: n/a -yes o
k
_Phot.p�: ye�
W vecAttache ai
A building permit may be required -by:
Note Lo�,al Planning jurisdiction)
Not S'
Notes/ gpecial..Condition
J. Agent or t lica rinted.N ar7e
U-Iiance statement on back of permit
Sig - hat Ure Please read cocoR
Application Feels) Check#
6
N "'70 ow
RIM
ng'Platform(s
..■■.■.■■..■..��....•■j
MEN■NEENEENE■
pi�r(s)
en _h
number
ead/ Rlprap le6gth
ayg distance offshore
Tax distance offshore
WE=
channel
cubic yards
■■■■■■■■■■■■■■■■■■
■1■■I■■I�■■■■■■e■■■�■■■■
ramp,
-iouse/'Boatlift
Bulldozing
MEN
ENEENEENEENEEN
i
EMENEINEMEN
MEMMM
n1ine Cer�gth■■■■■■■�■■■■■■■■■■
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not sure QQ1ii®pia■w�ii�eiiiii
yes
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See note on back regarding River Basin rules.
714
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0000000�/,
PermitMffi'eg" rintedN V
Signature
qc2 C,
Issuing Date Expiration Grate—

Authorized Agent Consent Agreement
I rW , hereby authorize py�,N—N to act on
(Pro rty Owner) (Authorized Agent)
my behalf in obtaining CANIA permits for the location listed betow. This agency
authorization is limited to the specific activities described above.
Property Address:
Property-Owner's:Mailing-Address and Phone Number:
aSQ % S-� VZNQ I -
Property Owner's Signature:
Authorized Agent.Signature:
Date:
Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date: / dLlh 2/?
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,
nr
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 ❑
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