67281D - Tatum

CAMA / ❑ DREDGE & FILL
A B
GENERAL PERMIT Previous permit#
5Ilew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources ` ,")
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (��; ( )
LL f ❑Rules attached.
it Name VTPfAYVA Thk'MVIProject Location: County ' 1 : W) yy volt
Street Address/ State Road/ Lot #(s)
State ZIP Ll � 1 i tit(n) & `�Vk "�-
Subdivision
� () E-Mail
zed Agent > �_ 1 V?. k`,,'k `&
i ❑ CW *W I)tTA S ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
if Project/ Activity
ock) length
'latform(s)
g Platfornl
pier(s)
ength
ember
ad/ Riprap length
eg distance offshore
iax distance offshore
:hannel
ibic yards
mp
use/ Boadift
ie Length
CiZIP
Phone # ( ) River Basin
Adj. Wtr. Body Nkw
nat
Closest Maj. Wtr. Bodyy`✓N'�
(Scale:
1�
ling permit may be required by: _
Local Planning jurisdiction)
a
❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: A,-T TN-1\-Vfl Permit #;
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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.
Excludesany
restoration
andfor temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Payment Proccessing Confirmation
Date Received 1 11/4/2016
:.heck From (Name) Joel Klass (Money Order)
Name of Permit Holder Robert & Anna Tatum
Vendor Moneygram
Check Number 20685992301
Check amount $400.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 67281D
Receipt or Refund/Reallocated TM/2859D

.AA
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 Aug. 15, 2016
Name of Property Owner Applying for Permit:
Robert M. & Anna C. Tatum
Mailing Address:
1416 Hatherleigh Court
Raleigh, NC 27612
I certify that I have authorized (agent) Joel E. Klass
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) a vinyl bulk -head ,
at (my property located at) 4423 Midshipman Ct. Southport, NC 28461
This certification is valid thru (date) r%' 30 — / to

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