72508A_HM2 Partners, LLC_20190103

tCAMA / )E DREDGE & FILL No. 72508 ✓
9�ENERAL PERMIT Previous permit# B C D
LA, ew El Modification ❑Complete Reissue El Partial Reissue Date 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 I SA NCAC is •
Rules attached.
Applicant Name 4 IM a /o r ru r L L f
Address 3 ci o io t-1 o n u.rwr A A yt
City R„ Hr�� State VA ZIP a3a1t
Phone # ( ) E-Mail
Authorized Agent `i, c. �J I V l �o VV'r
Affected ❑ Cw MEW lyl PTA CA ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / 0 PNA yes /
Project Location: County _�o r t
Street Address/ State Road/ Lot #(s) 1301 pvcK 1?,4
(' A-)c—t�,\ _ L,+ 30
Subdivision No e i"d,):1 1 A 4 J, 4­v-�
City t_ IC ZIP A } C, 4 4
Phone # ( ) River Basin C, S`
Adj. Wtr. Body k So,.o o c) iKa_t ban /unkn)
n
Closest Maj. Wtr. Body ` u V/' r " � v 6 k Sow /� c
Type of Project/ Activity ` I , Y. bp v v.4 w JI A, 1 Kt. �� l k 121 e. L--C k �..�, .� �Ma x a.1 v } �i yr r x, sr,.�,I
114 411, K.ys- r\ (Scale: a 0 )
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Pier
Fixes
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croi
Boat
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MMMMMMMMMMMMMMMM
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length■!■■■■M■■■■■■■■
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number
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avg distance offshore 01
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max distance offshore
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dine Length
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A building permit may be required by: U U c
( Note Local Planning jurisdiction)
Notes/ Special Conditions
UI
Agent or Al
Signature Pliase read compliance statement o�nJ back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Z ,G d,
PermitOffi ante ame
ture
IA)Anig ������►�
Issuing Date Expiration bate

N.C. DIVISION OF COASTAL MANAGE
AGENT AUTHORIZATION FORM
Date
' e-2- T I K
Name of Property owner Applying for Permit;
Mailing Address:
4q Z VttcL
0" r Ale"
I certify that I have authorized (agent) ent) ti/ �L � tt #*-otU to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct {activity} r`'""�'i-�"� � LLA 14 O'CA'a 3,4410, AJ7
at (mproperty located at) ��3 2- ,%G. (LO t >Vd4 C.
y P p
This certification is valid thru (date) `_�'Ly►+"-�-- 7-5
-- OL
Property Owner Signature
2s- I I r
Date