Best, Jake

��El CAMA / ❑ DREDGE & FILL I I , ' N9 78451 A B C D
ENERAL PERMIT Previous permit#
L New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality I -
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ? /
j l 0 Rules attached.
Applicant Name
Address
City �' ` I State 1 r ZIP
Phone # (. .) 1! E-Mail `
Authorized Agent
Affected ❑ CW Fl EW 0 PTA .bES ❑ PTS
AEC(s): 00EA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity f'
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap lei
avg distance of
max distance c
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
Shoreline Length _
SAV: not sur,
Moratorium: n/;
Photos:
Waiver Attached:
Project Location: County
Street Address/ State Road/ Lot #(s) I
Subdivision
Citv ZIP
Phone # ()
Adj. Wtr. Body_
Closest Mal. Wtr.
1. I .,C• ,.,F,
River Basin
-(nat /man /unkn)
(Scale: )
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions 't' rt \,� I (/• aA� '' ' �r i ` k /
i
Agent of Applicant Primed Name -
Sigture ",?44ase read compliance statement on back of permit"
Application Fee(s) Check
I A('./"i ( `/)/)C l/
PermitOffcers Printed Name �.;.'�
Sirature
�rC
Issuing Date Expiration Date