74797D Thompson

Oorized
CAMA / I DREDGE & FILL NO. 7479761
ENERAL PERMIT Previous permit#A B C
ew -]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issuedAs autby the State of North Carolina, Department of Environmental Quality /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 6-
(] Rules attach
Applicant Name ( tM0 Project Location: County O'J.AJ v, r
Address V U Street Address/ State R ad/ Lot #(s)
City \� . (� � U�' tateP c ZIP -: }a 1,5 �,' I V A \�'Jf-S
Phone # O
E-Mail
Authorized Agent
f e—& `
❑ CW
EW PTA S ElPTS
Affected
Affecte ElOEA
❑ HHF ❑ IH ❑ UBA El N/A
❑ PWS:
ORW: yes / Aoaj
PNA yes /
Type of Project/ Activity KR.b'j ,\ a b.,
Pier (
Fixe(
Float
Fingi
Groi
Bulkl
Basir
Boat
Boat
Beac
Otho
Shor
SAV
Mon
Phot
Wai\
Subdivision
City 90,Ax, zip
Phone # ( ) River Basin
Adj. Wtr. Body A\\4\j / nrat?man /unkn)
�� Closest Maj. Wtr. Body w1
r
(Scale: N TS }
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max distance offshore
cubic yards
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ramp
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Length
not sure
yes
5r Attached: es
v
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions 0
AA"A �/"
IK V-XJ k
.p �-
Agent r plicant rint am%,.. ____
ign re �`�` PI read compliance statement on back of permit t
/Y UM � T11-+ '';
ApplicationTee(s) Check #
k❑ See note on back regarding River Basin rules.
V /^
Per ed ame J
Signature
2--U 19+U-20
Issuing Date txpiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Namedf Property Owner Requesting Permit: mtnn�L ©V%
Mailing Address: , �a,� („ _Nueva+a
Phone Number:
Email Address:
I certify that I have authorized
Ir; V1.L ;k7;�kS -- 4 4 `
Agent J Contractor
to act on my behalf; for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: e-06'lCs Qe 13&Vhl
. - ,t _
at my property located at
in sr-tm< W;ck County.
l 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:
Signa re
i�✓YIU� D Oh
Print or Type Name
Title
�l �l
Date
This certification is valid through / 13 " I Z 0

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as se�atie,3sn$t�rir below
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Data R-1—d
Dan DP,,Iftd
Check Fmm
Na of PWmrt Holder
Vendor
Check Number
Cheek
ount
Permit NumbwlCommenb
Recelot er Relun&R.adl tad
Columnl
Co1umn2
Column3
C.1-4
Columns
Columns
2
Columns
C.1—n9
12/10/2019
Savdrelom Coral Corrtrucoon Co. _
Holden Dock.v B.Nd—da.11 ol2)_—__.
Holden Dock.and BJWaaN (i oR�_. _
Mary Cribb _ _ __.
Tn�+YT Fon _
Tnas�Y Tlimnaoc_ _ _ _
sellll ShOa Bank
11303
400.00
OP R3611D _
OP974797D _ __
PA rt 7349
12MOMO
CnaCan Bank
3n9
100.00
B81ct W58
12/1W2MO
cm c— B.*
_.
3779
300.00
OP 674717D _ _ _ _
BB L 94W