74710D - fairfax

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CAMA / E DREDGE & FILL No. 74710 A B C
GENERAL PERMIT Previous permit#
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality t
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �� r' 1 C
❑ Rules attached.
Applicant Name CZ-) ^ 2 FA � f- r- X Project Location: County2 N S ,- I c 1
Address 'Z 5 `1 ara Tf P/\-A t-k tLU Street Address/ State Road/ Lot #(s) l
City Mcx, a c � ,� \� t State N L ZIP 1 6 w A, S on � 1�2 .
Phone # (-72o') 4 SO T 5S I E-Mail Subdivision
Authorized Agent (V (2 E t, L IBC •./ City H 0 t �� E - J ZIP y coZ_
Affected ❑ Cw ❑ Ew ❑PTA DES i�PTs (,L-.,i Phone # (`� IG) SDI (� Ul 6 River Basin r'„ 6 e fc--
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body N/ L— (nat dO T—�/unk")
❑ PWS: Closest Maj. Wtr. Body t V/
ORW: yes / PNA yes /, `I W
•Type of Project/ Activity 1ZC fk A4 /3,c1c-tiEAc�o ►4 SAS- f 17u- pa t ti T.
(Scale: =ZV ') r
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ iprap length L
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing I
Other H G .. 1 6 U C-r+'
:I l
Shoreline Length
Of
SAV: not sure yes
Moratorium: n/a yes t
Photos: yes sIVA W I I_
i
Waiver Attached: no - -- -
A building permit may be required by: /-J o tl C'J F A C See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions Q vL Ic F-A C F A& v e t SAME L j PrS c N I
Agent or, Applicaht Printed Name
i
Signa e * Please read compliance statement on back of permit"
`DU``r--
Appl tion Fee(s) Check #
\ 'Y c ^ C1 4--
Permit Officer's Printed Name
Signature '--
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Check
Date Received
D-,e Deposited
Check From Name
Name or Permit Holder
Vendor
Checlt Number
-moon,
Permit Number/Comments
Receipt or Refund/Reallocated
Columnl
Column2
Column3
C01-4
Columns
C01UnM6 I
Column7
_ _ Column8 _
_
Cofumn9
10/18/2019
Holden Dodos & Bulkheads/Greg Holden Gary Fairfax CresCom Bank
3727 $
400.00 GP 74710D
TMcG rct. 91025D