72760D - Lee

❑' CAMA / ❑ DREDGE & FILL NO. 72760 A B C
GENERAL PERMIT Previous permit#
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
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
f ElRulip� ttached.
Applicant Name, C� Auck/l✓ l Project Location: County /` S10 co
Address `� r z — Street Address/ State Road/�oJt #(s)
City v✓ StateA%G ZIPY�/S'"
Phone #)2�4 Z90 E- ail Subdivision
Authorized Agent
❑ Cw
Affected
AEC(s):
❑ OEA
❑ PWS:
ORW:
yes / no
o f -7V !'i+
)XPTA
>5�11ES ❑ PTS
❑ HHF
❑ IH
❑ UBA ❑ N/A
PNA
yes />
Cityti ZIP Z
Phone # River Bassin
Adj. Wtr. Body ��'%'�' /f /1`U nat unkn
Closest Maj. Wtr. Body
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Agent or APR' Printed Name
gnat a Please read co pliance statement on back of permit
Appli tion Fee(s) Check #
Issuing
Printed Name
---/ q —1 1
Expiration Date

rage i or i
AGEN AUTHORtZAT1QN FOR LAMA PERMIT APPLICAMI+1
Name of Property Owner Requesting Permit: ( G1 1A1-
Mailing Address: J,, ,? {� _ + t C.1- I �1
h c aFIIau11:�
Phone Number: -1 CI - a }OI -
Email Address: L t P rec 4-1 (6 (� a�`f�CA O • COM
I certify that I have authonzed j,', f-rl-j ni4 1 E- ny)(-f+ McA r-io ° C x)S-I�'uc+fu-)
Agent I Cordradot
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �Al A G 1 \ (AV- I l-L 0, 5
("Cl \ St(x wu l'1 fJG n e1i S
at my property located at 1 C��1 0� LQ`M S+_ti Su r-f Cli . TJC
in _ �i (1SI OL,-% 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 intormation related to this
permit application.
Propwty Owner Informatw:
Signature
Print or Type Name
!iu"IIWw n e K
Title
03 } Da I &ACI
Date
file:///C:/Users/finma/Desktop/Jen 3/8/2019

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Date Received
Dete Deposited Check From Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit Number/Comments Recei t or Refund/Reallocated
Columnt
Column2 Column3
ColumM
Columns
Co.,
Column?
Column,
Column9
3/18/2019 JerryEnnett/Ennett Marine Construction Cecil Lee Coastal Bank & Trust 2163 $ 600.00 GP 72760D JD rct. 7907D