72720D - Efird

-� YCAMA / DREDGE'& FILL
GENERAL PERMIT
XNew ❑Modification ❑Complete Reissue El Partial Reissue
A B C
Previous permit #
Date previous permit issued
No. 72720
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '% N . j 2 O O
❑ Rules attached.
Applicant Name _RANDY EFi IZo
Address 154 Ll Lit-ly5 Egiw r_ RA
City Mov\NT C I LEAS State ZIP 2 7 3 o (J
Phone # (110) 00 - 14 S L E-Mail W I'A
Authorized Agent H 5 C OV S T Ru c T i o A/
❑ Cw
gE
)(PTA ❑ ES ❑ PTS
Affected
AEC(s):
❑ OEA
❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW:
yes / S
PNA
yes / ©o
Project Location: County L7. FL Lk N c I i C K
Street Address/ State Road/ Lot #(s)
C U A/C QV_ P7 STR 1E F T
Subdivision JV/A
CityUcFA�/ -Ls,F iF_.tcrt ZIP 2 84&W
r:,-J -, Phone # (910 ) WO-43R1 River Basin (-,AtAcre-g_
Adj. Wtr. Body CANAi., (nat a /unkn)
Closest Maj. Wtr. Body ,A I W LA/
- J
■■■■■■�■■�■■■■■w■■■■�■■■w■■�.��=���
MEN ■■I&■4OP.
J►cd�■■LAsI-LZ:c■■M-ic•KW■c+Z�■■■■■■.
ii■i■i��iiili�n
iii�■
■ii�ii■®■■i■i■
■■■■■■■■■■■■li
ii
iill\■G:l■■
\\■■11■■■■■■■■■■■■
M. ■■■■■■■■■■■■■■
` ■■■■■■■■■■■■■■il■■■■I�I1■■■
I■p■I !! I��t�l�i■■■ ■■■■■■■■■
\\Ik111■■■■■■■■■■■■
� �■■•••••
••� �■1 ■11=011b.■■■■M■■■■■.
ME
■II/trl1�!!�l111■I■■■i![G�iltl■I
■1I� Gri.'■ ■■!!■iiii.:�: �.
�illn�l iwiil■iiA�•i,!■■��■�i�l■11"R■1■�i■
• ©=■■Ka■
SNIPS!
PS■�■��
:=MWMIMKAU■■■ll`!■ A%
■w0■■■i■i
_A■M_
�i■■��■■■■MR1■■
M 4T-T I-f v ✓I/
Agent orApplicant Printed Name
Signature ** Please read compliance statement on back of permit **
S Z0 0 -0- 22 38
Application Fee(s) Check #
I"/LEt2 M c G u 19-IF_
Permit Officer's Print Name
C
Signature
L/%1201g &/&/201�
Issuing Date Expiration Date

�t
�
DENR
Ne tt, Car na Depart.rient of Environment arc Natural Resclunes
Denson of CoarsW VarWerr*M
Eeve,ly Eaves Perth efax"an C. Gavis Dee Free!
Governor Director Secretary
AGENT AUTHUNIZATION FORM
Daje 1117119
Name c• Property Owner .;; PiM vnq for Permit: Narne V ALdheAzec Agent or Ms protect:
Randy 1 ! , H5 Construction
Owner's Marling AdKJress.
t5�4 t alys a ad.
rl+t G=lead, NC 27316
Agent's Melling Ada,ess
21614 Holden Beach Rd
SjWy, NC 28462
Pt+prte Numt?er t 9 2Q # 6 jt3 245Cs _ ._ PhCano NurtiDe ,` — 1380 _41EI
E Certify that 1 have awthor�zed the agent: ►rsteci above: to act on my behait, for tne purpose of applymg
for arm obta►.,wV &H CAlAA Pefines necessary to mstatt or construct the k9lo%wq (actrnsy):
Inslail wat gift Wttn;dings
e-"L
Fof MY propwty located at 7 Concord = 016
finis certification is va�td thru (date)
Pro y Owner Stg re Date
P'^" 9t€? 7M FAX 9ti -� W*r
`r{ W
N�4 C,a#►o/tt' a
at MAY

A ENT
IName of Property Owner!
_SN
(Addres=,. Lot, Block Road! etc -I
,City,7own and!or County)
1 havevo owectior. W, lnl`,. urvix3to4
3 'Iave oble(:11-0-•IS 10 !'!Its
DESCRIP'nON At WOR 0RAW4NG OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below of attach a site drajeqgj
! 00al Ir' cnd no"
JSE)dsting
Floater
4
M
0 LU saw
Q�
CL
7CONCORD
WAWER SECTION
I undwstand it a pier, dax�, IrOO-SN, 1-1i
MC 14. NOU wist, !0 wave 111-C, sf-"bat'k yrx., must initial toe tta-vk Melrw
00 !e 5
00 not 'G -Irlia-ve ­'e
-wit-
'P
n d, Er F r V + d
15;t9 U",'Ivi Srdlpz Read
C_o
CL

�'�?r� :�'�'�'•l �;�}�ybi �'4�1iv'AY:4,f.�'�4fr� �e�'�.i4',��`�CNj'.. •
-ti
,
4wi:Y�ii�3'�, ,- ... � �..: , :�V�s�•�i!'DG� .��.4`';,G��'-31"�`�'�� ttr�li�'
VE
fnce+Rdat1tt rid
dtr#pt�iu.{t #t'pfTsrt� ielaiw rr ztY3 t� Sits rit�i
iI Wnh peiGct
Gtootor
4
♦" 14sw
Mo
m-+. ��i ` �,.� v.�v� lip �t�ar�. �� ��if�a��c�n� iG�lovt.i.. , • .
-
_re C_ w3&h to svu ti 1tEtFldiiC Yi: ' ` _ _ �;
kFG4ittiflie
Owner ojkhutf�
ow
r - . Vim-: :�! �• �j'� � .. - •
�^ tVifS+l4ay .7 �r
AW610
•� f�r�tlfll�4��+�J7't�+ ��f4f�,'J. x•.�.�..,.:.r

Dab RacWred
Dab fad
Cheek From MMW
Name of Parmlt wow
VaWor
Check Number
CINar
amount
P.-* NumbenCommenta
Roc* t"IW.. ft"#ocated
Colurnnl
COI~2
Calumn2
Column{
Columns
Column6
Cof m 7
Column8
Coh-9
7
7