Cozart, Edward & Rachel

®^ C`6AMA / ❑ DREDGE & FILL NO. 74930 A B C D
GENERAL PERMIT Previous permit#
[]New ❑Modification []Complete Reissue 0)6ial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ' )
and the Coastal Resources Commission in n area of environmental concern pur oiant to 15A NCAC /
_ LJ Rules attached
Applicant Name ! -'V �(- f ' t. 4 ! ( ' Project Location: County�r
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A building permit may be required by:
( Note Local Planning jurisdiction).,
Notes/ Special Conditions
Agent or Applicant Printed Name
❑ See note on back regarding River Basin rules.
-A-
PermitOffcer's Printedlyame
Signature ** Please read compliance statement on backofpermitt**
Application Fee(s) Check #'
Signatur
it l t
lssuiiirg—Daite Expiration bate

AGENT AUTHORIZATION FOR CAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: 'F VfV / L
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
7a(oen Sefk©e(.je
N cr
a5a- 99-38GL
Agent I Colttractor
6Asa-as4t -455aC)
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Pt --r
at my property located at a OS l�V,_-4 fV6 �J n� or e t i
in �F`p Tev e County.
I furthermore certify that l 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: p �%
Signature
Print or Type Name
(S) W pal '-i/ `7
Title
Date RECEIVED
JUN 03 200
This certification is valid through 1_ I
DCM-MHD CITY

��.
AMA / [ No. 7�420 n s DREDGE h FILL previous permit #
NERAL PERMIT z
_ Date previou permit issue
ew C.IModibcation ❑Complete Reissue []Partial Reissue '(.
OA11"Iho zed by the State of North Carolina, Department of Environmental Quality f �,
and the Coastal Resources Commission In an rea of environmental concern p rsuant to ISA NCAC les hod
Applicant N me_ f-I� Project Location: Coun
Address _ _ Stre dress) State Road/ t #(s
City _ State _ ZIP,_
Phone #p3 Subdivision ---
E-Mai— -"
- ZIP
Authorized Agent City "-
ver Basin
Affected `"OO �W ryPTA ❑ES . PITS Phone (_) __
AEC(s): ❑OEA LJ HHF 6661H OVBA ❑WA Adj. Wtr. Body_ nat. unkn
❑P
ORW: yes / n y PNA yes ! Closest Maj. Wtr. Body. --
Type of Project/ ActivityT. r -'� I�
{ Jbt t (Scale: IV )
Shore
SAV:
Mora
Phot
Wai
;dock) length---
t;.-
ver
TT
Plasform(s)Lv _
t
ing Pladorm(s)..l_O�.1___.
t length
number
r'44
._.
read/ Riprap length
avg distance offshore` �
max di distance ofrsftore �- :.. _. _
channe��
tstr�s -
Jl
cubic yards-. Ci�
ramp'
[ousel oatLR aG
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.f iv
h Bulldo:ittg,--__
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2cts
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_._
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ust�r
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lme Length .
not sure
torium: n/a yasf
-.
os: yes
Attached: yes .
A building permit may be required by: ��0)
( Note Local Planning jurisdiction) T
❑ See note on back regarding River Basin rules.