74797D - Thompson

CAMA / _. DREDGE & FILL AA YV
ENERAL PERMIT 0-Z3.ZCZO
New ❑Modification JComplete Reissue Partial Reissue
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 I SA NCAC
Applicant Name I tMr 0
Address
City . � I ^ _fta eP <— ZIP �'}2
Phone # ( ) E- ail
Authorized Agent (-eU\ `
Affected ElCW J EW PTA s ElPTS
): ❑ OEA ❑ HHF ElIH ❑ UBA ❑ N/A
AEC(
❑ PWs:
ORW: yes / 6 PNA yes /
No. 74797 A B C 6P
Previous permit #
Date previous permit issued
I-1 Rules attached.
Project Location: County 1✓� ^S w
� r
Street Address/ State R ad/ Lot #(s) %
Subdivision
City t cAx, ZIP
Phone # ( ) River Basin
Adj. Wtr. Body A\O\-j e Tw?man /unkn)
Closest Maj. Wtr. Body��
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Agent
Sgn re ** PI read compliance statement on back of permit * t
Per ed
Signature
Check #
Issuing Date
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name -of Property Owner Requesting_ Permit: D OG ©Y,
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
L -2., 7),`S — 4Hi
Agent / Contractor
to act on my behalf; for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
. - if _
at my property located at
in ,rt,► < 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:
Signs re
i-f Oh
Print or Type Name
Title
iOf-s— l
Date
This certification is valid through / 13 J / Z 0

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Date RO—Ved
Daft DOPO~
Check Fom (Name)
Name of Permit HWdw
Vendor
CAadc Ikm by
Chalk
amola7t
Permit Numtxr/Comments
R or ReM1lnd/RWlacated
Cdumnl
C.1-2
Cdumn3
Column4
CdumnS
ComtwW
Cdumn7
CdumnB
Cdumn9
12/102019
Soue»aecern C-1 conetrwc Co.
Hdd Dks end Bulkheads(1 d 2) - ._
oc
Hdaen Docks aM BUIkMaCs (2 02)_ -
Bell Pro es
Cariom
Sash Sorts Bank _
CrwCore Bank_
113D3
400.00
GP R35HD _
GPpQWD -_
GP a74797D _. _ _.. -..
PA rt 73<9
BS—Na
BB nY 9359
12HN2019
T
3778
100.00
12110/11119
Tlmoth
C—Cem Bank
3779
It 300A0
_
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