74399D - Fairfax

CAMA / DREDGE & FILL No. 74399 A B C
GENERAL PERMIT Previous permit #
QM il New -'Modification E]Complete Reissue ❑Partial Reissue Date previous permit issued
As aut onzed by the State of North Carolina, Department of Environmental Quality Z v
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC o-1 ( I - ( 4
❑ Rules attached.
Applicant Name Gal lr�;­ / Project Location: County��..5�.
Address � SL/ { J?, 1 "` �?� Street Address/ State Road/ Lot #(s)
City %\vo ( Sv, ((e State tJ C- ZIP Ps e I 0 s
Phone # ` may' b E-Mail ,A—_ Subdivision 11
Authorized Agent h �G�� City �(n j� 1� nn .,CN ZIP 2 YY(y,; -
Affected ❑ CW KI EW KOTA ❑ ES ❑ PTS Phone # ( ) River Basin L , tic-/
ElOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body (na1�1m. /unkn)
❑ PWS:
ORW: yes 2 PNA
Type of Project/ Activity _
Pier dock len h-4, W 4 1
Fix
Float
Fing
il
Groi
Bulk
Basin
Boat
Boat
Beac
Oth
il
Shor
SAV:
M0,111
Phot
Waive
yes / no::;?
Closest Maj. Wtr. Body A ( , -✓ LJ
(Scale: N r S
■■■■■■■■■■■
■■■■■O■■■■■■■■n
■r�i�■cv■■■■■■
■'iii■■■■si
lommmmmmmmm__mmi
NaEii■■■■■■N�■i■■
length
►n■EN�i■Ei■■■■■■■■■■■■
number
avg distance offshore
max distance offshore—
■■■■��■■■■■■■■■■■■■■■■v■■■■■■■■■■MEN
■■■
■■■■■■■■w■■■■a■■■■■■■■■�r■■■r.'■■■■■■■■■■■
■■■■■■■■■■■■■■'���/:a1�r■1r
�!
MINN
■ION
A'■■■■■■■■■
cubic yards■■■■■■■■■■■■■
■r■lt���
ll is
i■
I■
Siil■■■■■■■■■■
ramp
■■
■■■■■■■■
■■■�111,■■,
i■
i■
�
i !�
■■■■■■■■■■■■
' '"'
■�■■■■■NON■■■■�■■■■®■�I■1'�■■�N■■■■■■■■■■
re'N'ENEEEEE
Bulldozing
ON
MINE
:i
sui:lmimmlmm
MEN
0
NEON
EM■■ENE■■■
-line Length
not sure
'�'
■sue■Evili■■■■■■■■1-2t-ii2pl■.uam■■■■■■■■wA;y
"Mrarp-
li
yes
iii■Ei
IEE■EE■N■EME
NEEM
ii■■iE
■■FoR
u
i
■■■■■■M
I■■■■■O■■■■■■■■■�■■■■O■
■■'ICi'.�lS33l►\■■
bs: yes .Iv
O■■OO■�IOO■■■■■■■■■■■■■■■■■■■■■■■■■■■r■'
.
■■■■■■�
O■■■■■■■■■■■■■■■■■■■■■
■■■■■■�
A building permit ma�g required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction
Notes/ Special Conditions ~l yrr �G� c \,�. .,. \\ n PK c c c. lQ� C 4e.,-A
J _
Agent rAp li Print Name PermitOffic ' t Name
Signature lease read compliance statement on back qTf permit Signature
Application Fee(s) 11 Check # Issuing Date E pira ion Date

T""d!iv v171
kI
Vat-1 l ^9

L
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 4��3.
Mailing Address:
o� 2eA V,Ors 41lac V
a �7
Phone Number: ��`� '���� S �,� �
Email Address:
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �(2Gc,4 Gf h C G 'y--/ >.re5
at my property located at
in ('Vy�� , County.
L1'bns rya w LDr . "40
/ 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:
All gnat re
Print or Type Name
0 U-) Y�-' 2(—
Title
02- /
Date
This certification is valid through / / I Z / 2 O

� T
WA,
—0/
zPG
oc
0 mpmwft OMW
-alp apsw as=* saq "IMMOSOMINNipano
Vim& Vumuupm
--.032vv
..............
-log y)
4vv
k t
L-d dC0:60'6L N 100

r!'
r
(C� and
tt� �s «:. se t[-:: 1 •- t .� 1•tSr.
. tt :.P:+.tF tf tE�' ! t * � t:: ul.i■�t t' a ! +-
'
:: is ii ts• t=_t!, t .•alttl !': �. t-.;•ME t �t :t et." '•
.t.t' i t:t E :FE;f: .i st s)r:i+ t! • xe - t -
.t is f')'t..�S } • t..ti t"iii: t. i:t t, ES r: " t . a t it Oil' tt -
E I)1 itltt.: tl.t:1' �. t t t t ) . !' t i s•E * t} E E .
!t= t t t t :iY•i.i Imo. tt ltiti !' 1 i i•.�•:
1 �lt�t� ems=WftRkgbm2WC 2&M Or caU !RO -39-- -3qm
� � � -the same as no ob'
� �taRe �e�t nee"��ia�. anif
a &N*a mGwft PWam breaka ry boat use 4W.O2t
sab&-asam"� infi�+siaax�eanr�acrss - wed by me. of
l i �•t S► -.3 Sl �..it •. ►. La'..
r't tt' act tt rr t''
S)env.:s
Rda Name_
AUVAWMb
MR
,!lomsto.il:,. nrv+saa.oe•,z•
�:-tltit2l.' ltlLi :e iEt :�: t l '