HomeMy WebLinkAbout66327D - HobbsLAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New ❑Modification El Complete Reissue El Partial Reissue
A g
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an ayba f e vironmental concern pursuant to I SA NCAC
YY ❑ Rules attached.
it Name l Project Location: Countya (r•1�.� '
yYU N 'a Street Address/ State Road/ Lot #(s)
( N -T State_ ZI P7S�Z'9:
t (J(p) 310H - [ I � `1 E-Mail
ted Agent
I ❑ CW
PTA
❑ ES ❑ PTS
❑ OEA
r ❑ HHF
! ❑ IH
❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes / no
f Project/ Activity
)ck) length
latform(s)
-ngth
amber
id/ Riprap len h
g distance offshore
ax distance offshore
hannel
bic yards
rp
not sure yes / I
rium: n/a yesyes
Attached: yes ✓�6
ing permit may be required by:
Local Planning jurisdiction)
J
Subdivision
City ZIP
Phone # ( ')"""" // -- River Basin / F
Adj. Wtr. Body H Of / Lriaiil
Closest Maj. Wtr. Body
v,-
(Scale: / if
❑ See note on back regarding River Basin r
NC Division of Coastal Mgt. Habitat Impact Computer Sheet
App licant:
Date: i
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. T(Apt
TAL Feet FINS
(Applied for. (Anticipated fiplied for. (Anti+
isurbance distuDISTURB TYPE Disturbancetotal disturbancetal includes Exchincludes any Excludes an
Habitat Name Choose One anticipated restoration any anticipated restc
restoration or and/or temp restoration or temp
tempi acts impact amount),temp irri acts amo
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 171
Fill ❑
Both 0
Other 0
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date U 44 - 1 ot -1 to
Name of Property Owner Applying for Permit:
�tamu-. ( {bibs
Mailing Address:
314 3 T( r,6- rLr-u c),t
I certify that I have authorized (agent)
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)
This certification is valid thru (date)
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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
C (e o m . G✓A 1 td
C-% Jo4,
f0 r30x 59
R -I, /rc 2 7 & z �
i
X /_ i ❑ Agent
`(/ ❑ Addressee
B. F Obeived by (Printed Name) C. Date of Delivery
J Cu, 4 (4 o
D. ir.,r�frii-s;erent p},item,i ❑ Yes
lvel q �3c[etis`tiel0w ❑ No
, M
0 1 III�III'II' ICIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 3. dutvl r/`J 5 ❑Priority Mail Mail-
❑Adult Signal u El Registered Mail*'^
❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted
9590 9403 0737 5196 1619 42 ertified Mail@ Delivery
Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. Article Number (Transfer from -Ilce label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation-
7 015 1730 0002 1686 8 311 ail ❑ Signature Confirmation
ail Restricted Delivery Restricted Delivery
PS Form 381 1, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this caul to the back of the mailpiece,
or on the front if space permits.
Article Addwe,
essed to:
I_r (/ k
PO (�
5��� C, f`�f �!c 28yHS
II I I I II IIII III I I I III II I II I I I III I I I I
9590 9403 0737 5196 1619 35
A.
X Agent
❑ Addressee
�Received by (Print Name) C. Date of Delivery
0. Is delivery address different from ite �21 SSA
If YES, enter delivery address belot No p
N
n
N
V / o
GsAs _ 9 \� �
3. Service Type
❑ Priority Mail Express@
❑ Adult Signature
❑ Registered Mail-
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
Certified Mail@
Delivery
Certified Mail Restricted Delivery
0 Return Receipt for