66262D - Gross

CAMA / El DREDGE &FILL a,' _ l'0-962 A B
GENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 1
,oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC H
/l ❑ Rules attached.
t Name 2600
\ 1 6110 ` 'VA 6 YS � Project Location: County �}% ►� jW l Ll L'
I )VI& ti' y' .1 I V Street{ Address/ State Road/ Lot #�(s)
✓c State ZIP �� G ; J t ��k (� Ll V �S� VC
E-Mail
:ed Agent I k-e 1d1 41116 yol'o--
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
XOEA '�J, HHF )(IH ❑ USA ❑ N/A
❑ PWS:
yes / no PNA yes / no
f Project/ Activity
ck) length
atform(s) _
Platform(s)
ngth
tuber
d/ Riprap length
; distance offshc
uc distance offish
cannel
sic yards_
np
ise/ Boatlift
ulldozing )C �C. X
e Length
not sure yes no'
ium: n/a yes
yes �nn
kttached: yes (ono)
ng permit may be required by: _
Local Planning jurisdiction) } i
V
Subdivision 0 /F
1Ci�ty )(` CLI�I S'u 16FG ck ZIP
Phone # 3 (River Basin
Adj. Wtr. Body I a ah [. Wa V1 ,(n( atA
Closest Maj. Wtr. Body )'` ArA o-h C Ch (A, L`
C41 . )( t 1/1 VFSL)C,
r}r, a 1 _ I - 1..1 I I i
(Scale: �!
❑ See note on back regarding River Basin n

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date January 6, 2016
Name of Property Owner Applying for Permit:
Richard Gross
Mailing Address:
2512 Matterhorn Drive
Wexford, PA 15090
I certify that I have authorized (agent) Ike Williamson
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
143 Ocean Isle Blvd. West, Ocean Isle Beach, NC .
This certification is valid thru (date) February 2016
�,.fY 1 /6/ 16
Property Owner Signature Date

It I
z itAW
i
i
i i x 'A A Lu n td the A

dD Division of Coastal leg#, Habitat Impact Computer Sbeet
pplicant: �.G��
ASS Permit #
'ate: e I
t
/�
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
abitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)_amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
Dredge ❑ Fill ❑ Both ❑ Othe
05D
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑