63473_Wayne Braddy_20181213

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'Amkj0 6AEO,GE LL.
.,,. No. 72932
GENERAL 'PERM,1T':
A" D
Previous p6rimit.#
I D P bate, previous periiiinii:isidi w PHodification ❑Comp ete Reissue., artial Reissue
A authorized by State of�46fth,Carolin part s Department of-.Environmentdl, Quality z
and theCoastal Re
61 §ourc,,;C6mmissiO6 iriia,n, area of environmental concern pursuant to 15A NCAC
,.,
2TU' es ita h d*
ProiectL&atio
ty,
Applicant Na n: Colin
Stapt :z
Address )'xo - r"; StreetAddress/Sike.116ad/ Lot' (s) #
,'City ip
F-Mail n z
Phone W 7/— V� _4 Subdivislo,
Authorized 3-
ty
El El E.,,,:, PTAEl ES S one 'Aiver Baisin-:,Y4,./,
Ph
Affected X.
-1 NIA
EIOEA EI,HHF El I H El UBA E
AEC(s):'. Aclj: Wtr. Body (nat- Imari, unkn
El PWS:
0 RW: yes NA yes Closest Maj. Win Body
,
IType i Oroject/. Activity
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NONE
MEMMEMEMIMMEMMIM■SLUMEHOMMIRAMENEW
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NMMMMMNMMMMMMM
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S i g'rI d F R leis6 rAd'i p I ian ce Oate m e nt on back of perm it
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lon,F.O(s) Checli
1 e-i
PermitOffi5e fN me
Signature
Issuing Date Expirationbate�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
. t
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in County.
I furthermore certify that ! am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
/ Signature
Print or Type Name
R�3 fO Li o'�
Title
Date
This certification is valid through I
I

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Authorized Agent Consent Agreement
qT, IV,/j
ereby authorize 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:
Property Owner's=Mailing_Address and Phone Number:.
Property Owner's Signature:
Authorized Agent Signature:
Date: / ) -- / �— 1
Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09

Applicant: � ll��///� 4 ��
Date:
//r���2
General Permit M
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)
n�
Dredge,J Fill Both ❑ Other ❑
- JR-
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
z
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 ❑
- -2B :a 1- -4 T : www.nccoas,.almanaaement.net revised: 2; 11B