63617_Doug Black_20190123

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{art,;MdAMA/ ❑DREDGE&FILL. • LJ�t�I G u• • d
w r No: 72947:'.
k ., GFE.NERAL- PERMIT � , ' v 1 .Previous permit# . . ° .• • , ."t�l I/", a•�`%) " ❑Modification LIComplete Reissue ❑Partial Reissue• Date.previous permit"issued " • f`i'• 1A
.;,,- New,' s a 601 /'
Ik::,As'autho%ized by.the State of North Carolina;Department of Environmental Quality'"
p and.the Coastal Resources Commission in:an area of,environmental.concern pursuant to ISA NCAC'"•' b 1 , • .2. ,- ,
. 1 Rules attached.
.`Applicant Name '7 t-t`L�' " 1.A z: 14' _. Project Location: County -- 1-114,-F7o.iS'" :•!O -: .
g.. Address:g I. (o! C° 'i V.3 v Y2Z i2 moo( , Street Address/,State Road/Lot#(s). .
Cif), 1^J �-+:r�-"1'1-1 \ - .State-) ( ZIP 2--)-g eL \ (c4 ' - '. -i v t P,t•~ -pc ::,..
r Phone# (2c,2) c1 V '';—'S(o2?j E-Mail - - " " Subdivision'12.1 1 i . 3 " : '_
,r Authorized Agent \/Z-�L j �� p City 1nJ�;t-lr-1 L�-t-7h� ZIP 2-15,�:`1
r§ ❑cW , EW PTA ❑ES ElPTS Phone# ( ` ) _ River Basin[A 9,1PIL'1 Ca r;
Affected ❑OEA CIHHF OIH ❑UBA • El N/A
AEC(s):. . . Adj.,Wtr. Body P�rAL- 4.0r-�1,v'� - ( %man /unkn)
• ❑ PWS: . ,�•
ORW:" .yes / no' PNA, yes / no "
Closest Maj.Wtr. Body .49AM LA L 0 • 1 V&'I-- "
Type of Project/Activity�I PW\--7-F !AJ Z.X /� .F10 r 1 lr� x' lam- , l_: 1• 'PLAT.r -A\
(Scale: )n"-z1..' . )
•Pier(dock)length 4 0 Y (c,
i 1 ; 1
Fixed Platform(s)-( (� x 1'-Jy Si �f�N1L !J• l 1l ..
Floating Platform(s) Q[ t 1 L- x 1Z f r--
i 1...-J-hr(1.�
Finger pier(s) I -___>
Groin length . I 4
•
'number. ! �:�c 1')�.1 :).
1.41 t- eov�a.t'0 -
Bulkhead/Riprap length ' j
avg distance offshore � � _• 1
I- max distance offshore �E--P(�-Z.-i~ �6! 'v 1? 'I D r t.3'1._ ; a '
Basin;channel i 'j
1.-y` 17nr1al
cubic yards I � \-
Boat ramp .
.Boathouse/Boatlift , •
&"CI-S-r11-\� "
Beach Bulldozing - � �, ' •
:, 51S V I 1/V'\- r;;)
Other
\ I \ - „ ,
NJ
a
Shoreline Length & -j A �' "" '
SAV: ` notsur yes no i ` 4
Moratorium: • n/a' yes no j `
Photos: yes nTj 1 }{ "PFty
Waiver Attached: - yes no . S '
A building permit'may be required by:12,,_-_-Av1' o;CL-e (0- See note on back regarding River Basin rules: •
(Note Local Planning Jurisdiction)
Notes/Special Conditions ( !o-1- 1-: NV A-i N.)T Al r-}-m-- ) / /�A )r , ••
I i _ ]G . 4E1/ _QA v-tom .
Pjgent p if
� Y cant Printed Nam7� mitOffic is Printed Name •
'. Signatur4 **Please'read complf ance statement on back of permit * Signature � N 2p j '
-::-'1'• . : 1C " 1,J �t v v-Y.7 I. 1 J'r- �-,3 =t..1-,Ai,,f.,�2.01� . '"�;�, --4
•Application Fee(s) Check# Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 4, 12,z 1title.- ` --0 1-1
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized N1 r'-7
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 Imo^ ate-,- ,- County.
I furthermore certify that I 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:
D\JJ\ kQA
Signature
\INC\ c\I-Ne ()UVE12
Print or Type Name
Title
Date
This certification is valid through I I

•
•Applicants 7
Date:`2 Pr-J
-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.
TOTAL Sq.Ft FINAL Sq.Ft. TOTAL Feet FINAL Feet
• _ (Applied for. (Anticipated final (Applied for. (Anticipated final
DISTURB TYPE _ Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
• anticipated restoration any anticipated restoration and/or
restoration or and/or temp ' restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
C:o .F-?\A'71�-n_ Dredge 0 Fill 0 Both ❑ Other
Dredge❑ All❑ Both ❑ Other 0
Dredge 0 Fill❑ Both ❑ Other ❑
Dredge❑ Fill 0 Both 0 Other ❑
•
Dredge❑ Fill❑ Both ❑ Other 0
Dredge❑ Fill❑ Both 0 Other 0
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill 0 Both 0 Other 0
•
Dredge❑ All❑ Both 0 Other ❑
Dredge 0 Fill❑ Both 0 Other ❑
Dredge❑ ,Fill❑ Both ❑ Other 0
Dredge 0 Fill 0 Both 0 Other 0
Dredge 0 Fill 0 Both 0 Other 0
Dredge❑ Fill❑ Both 0 Other ❑
C)-