66611D - Outlaw

-ICAMA / ❑ DREDGE & FILL i( l/ ' b A s
GENERAL PERMIT Previous permit# _
]New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
i ❑ Rules attached.
it Name -� V�,1'1_ i (/ U �� T Project Location: County
r'",P "V -9a� Street Address/ State Road/ Lot #(s)
✓( State ZIP
(�� U E-Mail
zed Agent
❑ CW
E�EW PTA ❑ ES ❑ PTS
❑ OEA
❑ HHF tl IH ❑ UBA ❑ N/A
❑ PWS:
yes / no
PNA yes / no
f Project/ Activity
)ck) length 7 �
latform(s) ! U
Platform(s)
)ier(s)
,ngth`
amber
id/ Riprap)ength
g distance offshore
ax distance offshore
hannel
bic yards
ie Length
not sure yes
1um: n/a yes
yes
Attached: yes
p
Subdivision
City /L/ ; y r .� r:i. �..1 ZIPS
Phone # ( j---- River Basin 10u711
Adj. Wtr. Body rvl� ���/��%� nat /
Closest Maj. Wtr. Body
(_-1-1
ing permit may be required by: a ? ❑ See note on back regarding River Basin r
Local Planning jurisdiction) _T

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
lhninc ni i4aJAf
Mailing Address:
I certify that I have authorized (agent)am—ki�&dL�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) Lq
Pronertv Owner Signature Date

k.KrAMA /I. -I DREDGE & FILL
0 ENERAL PERMIT
ew Modification -]Complete Reissue (_'Partial Reissue
M 6611' A B
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
e Coastal Resources Commission in an area of environmental concern pursuant to I S�Aj NCAC
ant Name 21 PU.� ��!L" U ~L , w' i J "rrojectt Location: County ❑ attached Rules
ua.
ss Street Address/ State Road/ Lot #(s)
StateZIP 7�3E �� U
. T T a f�� �✓i't, �-t,�
#�/. )C/ rP�U E-Mall Subdivision
rized Agent _,. �' /iE- City ��" 7 �%�z" 1 ZIP 1 S_
t- C1M E1+v b� PTA DES C PTS Phone #ad
( ) C River Basin L_✓�
OEA _1 HHF C IH Cl U" 17 N/A Adj. Wtr. BoIn
/ �V IT / nat
PWS:
yes l� ; PNA no
Closest Mai. Body ✓ ►_^ �'
of Project/ Activity L. 1n 5 TLIl� t vC!? c+%L ` `t Ct z l L L
d4xk) length _
Ptodorm(s)
Ing Pladorm(s)
2_
CZ0
avg distance shore
max dlstarxe
channel_. -_--
cubic yard
ramp —
0
ova.
ine Length not sure ye: C.'T "
corium: n/a yes )
is: yes no
r Attached: yes
Iding permit may be required by: / .! _•144e GL�
1
L! See note on back regarding River Basin

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