Hodges, Dempsey

LJCAMA / ❑ DREDGE & FILL { No. 73481 A B C D
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GENERAL PERMIT Previous permit#
lew DModification ❑ComAlete Reissue El Partial Reissue Date previous permit issued
As authorized bythe State of North Carolina, Department of Environmental. Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name Project Location: County
Address 'AI, d -J- t`-
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Street Address/ State Road/ Lot #(s)
City I / -
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StateZlP ,-
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Phone # r
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(E Mail
Subdivision -
Authorized Agent 1LLLL�
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City-- P_
Affected OCW \CJEW
%❑HHFH
PTA DES ❑PTS
Phone# O-_� _'River Basin
AEC(s): OOEA
❑UBA ❑N/A
Adj. Wtr. Body
❑ PWS:
Closest Maj. Wtr. Body - --
ORW: yes /:no) PNA
yes / no
Type of Project/ Activity
Pier
Fized
Floati
Finge
Groin
Bulkh
Basin,
Boat
Boat
Beat
Othe
Shon
SAV:
Mora
Phon
Waiv
A bui
( Note Local Planning Jurisdiction)
Notes/ Special Conditions _
Agent or Applicant Printed Name
Signature ** Please read complian& statement on back of permit"
/(nat /man /unkn)
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Permit Officer's Printed Name
Signature
Issuing Date Expiration Date
Application Fee(s) Check#�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: r1 B+C ('C s'
Mailing Address: C 7 9 G- C/
Phone Number: So
Email Address: DeMP>'e1
I certify that I have authorized t:> Lk) v w R R 2 �� Ash. = �O `iA �tiGlti
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: k c- 5 1 •'tu c i Y , -/
O F Gk/ S 1 1y 12 t>!l - %U
at my property located at �U 7 �>/ f ✓�2� �% /�02C-I{[--/�� CF/j
in C✓a 2 %c:� ,� c—T 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:
ignature
Print or Type Name
CJ lit' lvt= ;C_
Title
Date
This certification is valid through I I

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