69052D - Bridges

DREDGE & FILL 5--tsa0
52 GENERAL A
PERMIT Previous permit # (s 11
uNew _Modification Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North drolin�a, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC100
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❑ Rules attached.
Applicant Name c n � q t Project Location: County96&5LNn C �
Address -1� I V ,Vi L 0 Mn I b,r,
City Ua ' I State-&AzlP ?,005
Phone #(U)9 6 05 10 E-Mail
Authorized Agent T fO IM r►azNr S.
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Agent or Applicant Printed Name ---
Signature "Please read compliance statementarrbackofpermit"
L460.60 '59 Lis
Application Fee(s) Check #
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Signature
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Issuing to _ xpirati Date

Date
Date
Check From
Name of Permit
Vendor
Check
Check
Permit Number/
Receipt #
Received
Deposited
(Name)
Holder
Number
amount
Comments
Erosion Control
Specialist of NC Birder Mae SF rct.
4/25/2017 Inc. Bridges BB&T 5843 $400.00 GP 69052D 4054D

jCAMA DREDGE & FILL vp,
l J-7 A B
GENERAL PERMIT Previous permit
MONew - Modification Complete Reissue L__ Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCACO-31A
E Rules attached.
Applicant Name(( Project Location: County
Address .�j V, �J Y) V-0 VA Street Address/ State Road/ Lot #(s)
1, J
City .YVN t­p V,^\ GA 4�ias State lS zip& �OLL- -
Phone # ( _"-P) " bl-15 E-Mail `­— Subdivision —
Authorized Agent _ -V- E Cityzip
Affected Cw _EW 0 FI OES 0 PTS Phore# River Basin �Lw
AEC(s): OEA HHF 0 1H El USA 0 N/A Adj. Wtr. Body V1 k_( (:&Ika -man /unkn
PWS: _I
ORW: yes no PNA yes / no, Closest Maj. Wtr. Body &A �LC - (Ijcm V-\
atform(s)
Platform(s)
er pier(s)
length
number
,-head/ Riprap length
avg distance offsh4e
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MMMNINHOWNEIRMSE
max distance offsoore_
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NO PS35 9 R 9 110 119- iNIA 00 M
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cubic yards
MEMO
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t ramp
thouse/ Boati ift
ONE
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RONNE
notsure yes
torium:
n/a yes
tos: yes
er Attac
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
C%
Application Fee(s) Check #

U II I elieU I / 1.1.31 H1115 P11r11111AIdl V AN r .VvdrVV 7
j�AMA /' DREDaF-& FILL
n ��V1T ® C
ENER�►L PE�iMiT Previouspermit *
6795 e Z C
ew ❑Modilkation OComplete Reissue OPartial Reissue Date previous permit Issued (> 'ZZ
As authorized by the State of North Carolina, Departmenc of Envlronmeht and Natural Resources r^�
and the Coastal Resources Commission In an area of environmental concern pursuant to 15A NCAC
` n pRuks cached.
Applicant Named i M aQ, n d q'� S Project Location; County
Address 6`� MN\ _ �.1' Street Address/ State Road/ Lot #(s)
City t .h&'k%� state ZIP �0 (0'1 �� Q C- ZNd ,
Phone # JI&) 6" - 15 E•Mail Subdivision
Authorized Agent TO w. k& City-�QA 1 \[ 1f. Y� ZIP
Affected OCW OEW OPTA OES OPTS
EA ❑ HHF O IH O USA O N/A
AEC(3)_
ORW: yes / PNA yes /
Type of Project/ Activity T
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Basin
Boat
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Bead
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A building permit may be required by; J t /� 0 t (J IM• ,K I'% Vs 1 ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurlsd"on)
Notes/ Special Conditions,
&Aid
Agent or Applicant PrMoed Narne
Signature " Please read compliancestatementonbackofpermit"
ApOcatton Fae(s) Check *
A rre l I
Permit 's P
Signature
I/ia o k 2 %zo 0
Issu ate % 6pirationbate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: '?) 't
Mailing address:\-
�3-�c���3CIO 7
Phone Number:
I certify that I have authorized -V(,m
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 4SG 't- a,nr) S!- r C`tir.,^i`SSiE
�C_
at my property located at 1�512- E :� LS C)ce,- )i : etc
in County.
This certification is valid through
Date
(Property Owner Information)
Print or Type Name
v ve K
Title
l ,
Date /
-- � L avt
Phone Number
mail Address

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION.
Name of Property Owner Applying for Permit: �(Ydff JG�h
Mailing address:
Phone Number:
-1() �0 - 1� N - 4a4-QH
I certify that I have authorized —TOm'�,) n- C V5
ent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 4
proat my perty • -• at 'n�
in :bYLLL�SI-q-) � c'V- County.
This certification is valid through - 2 o l 12
Date
(Property Owner Information)
' I6 --, "-'JSignature V—
t re i V
Print or Type Nartie
awne i
Title
to
Date
�l 0 (o - 4o\ - \Sc1
Phone Number
mail Addfess