Roberson, Michael

AMA / ❑ DREDGE & FILL
EN ERAL PERMIT
New ❑ Modification ❑ Complete Reissue
As autho ized by the State of North Carolina, Department of Env
and the Coastal Resources Commission in an area oftenkir"Aent
Applicant Name
Address
❑ Partial Reissu
ironmental Qyali
City d VTA X AAM Stated ZIP i
Phone # E:Mail On% N
Authorized Agent n
Affected ❑ CW XEW IOTA ES ❑ PTS
AEC(s): ElOEA El HHF El\ BA ❑ N/A
❑ PWS-1
ORW: yes / 1yc _� PNA yes /
Type of Project/ Activity
Pier (dock) length �-
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes r
Moratorium: n/a yes n
Photos: yes n
Waiver Attached: yes 4
A building permit may be re4uired by:
( Note Local Planning Jurisdiction)
Notes/ Spftgial CondOngs
CC
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Applic ee(s) deck #
0-0�
No, 76338 A B D
Previous permit #
e Date prqvious permit issued
ty
ant to I SA NCAC
QAV-� ---�le�s-attacppd.
Project Location: County
wcr--
Street Address/ State Road/ Lot #(s)
)�' 5, 5 1
Subdivision , A
#J& 64
Closest Maj. Win Body
Perm
an
(Scale: )
❑ See note on back regarding River Basin rules.
J
Expirdtion Date