68066D - Dove

'CAMA / ❑ DREDGE &-FILL �` �Itarr,�a,•p�j, 1��6 A B
G EIM E RAL 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
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 67 �� 5'0 0
( ❑ Rules attached.
it Name Project Location: County 4LOA SVN7 !--
i2 �;2"'1 uv-eA
r�AAZIt) }1"L State /ZIP2:lZb%
) ( 0 1 - q 161 E-Mail
zed Agent &VA (. (0" �-M h a N
I ❑ CW �*W *TA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / (PNA yes /
of Project/ Activity
e1 (J,-e�✓I�
)ck) length /
latform(s)
Platform(s)
mgth
ember
id/ Riprap length
,g distance offshc
ax distance offsl7
hannel
ibic yards
mp
use/ oat
lulldozing 1
5r ie Length �
not sure yes V
rium: n/a yes V
yes '
Attached: yes �lh� J{!
ing permit may be required by:
I nral Plannina lurierlirtinnl
Street Address/ State Road/ Lot #(s)
1`70 (aor4
Subdivision "
City— _5"y"s-t. (7c �t ZIP
4 ko T# (` (d ) T7q" 7CJ5 River(� Basin �
Adj. Wtr. Body C 6( tit Pe.(n/at j
Closest Maj. Wtr. Body LVW
�- I M d u
Z A Vq- /1 t4i
(Scale:
I (�V� Y 1 d J SC �Jc ❑ See note on back regarding River Basin r

1/17/2012 09:13 9105799096 GRICE CON
*N � 7 \
q
XCAMA / . I DREDGE i FILL
ENERAL PERMIT
l ew L :Modirication 11Complete Reissue I 'Partial Reissue
tut rised by the State of North Carolina, Department of Environment and Natura
the Coastal Resources Commission in an area of environmental concern pursuant
i
Ilicant Name �Z ew C. Pro
Iress 2 3 i �p3Wt A it? Str
y`
' 1 TaaL StateNG zip �V�7
IIb
ne #f (10q) &1_41 02 E-Mail ! Su
...1
honied Agent Cb�/11'1�I I o N CI
!cted i CW / ' �A IS L PTS
rr
le
+(s): 1 OEA IF I WHIP ' I IH USA 1 N/A Ad'
I
IJ PWS;
N: yes l() PNA yes / Clo
ae of Project/ Activity
a �
tAPxt m
tr (dock) length /
ted platFo $) q
platto YI `
`
iotint ') . /'
F1004
4w P�*(s)
Gin length
number
+ •
athead/ Rtprap length
_
T "
avg distance oNshor
i
I l5
man. distance off
l
sin, channel
i
cubic yards
j
at ramp
athouse/ lift
ach Bulldozing
he,
xellne Length _
5o L. .
V; not sure yes no
ratorium; rVa yes no
xos; yet no
aver Attached: yes no
K alding permit may be required by.
kxe local Planning Jurisdiction)
PAGE
N4 68066 A B
Previous permit #
Date previous permit issued
Resources l �7
I SA NCAC 61 IT • —goo(6-7 4 -1741
L Rules attached.
Kt Location: County
t Address/ State Road/ Lot #(s)
ivision
bwsM L'�' �l�G ZIP . 0 q
# (1I0 ) 51 `i — Ro15 River Basin _IUV
tr. Body CllI�1 ������ ��(n��at
st Maj. Wtr. Body � _..._
0
I( (°M
IA
I I
/) r - — .. n i I_ I
WOLS
I
(Scaje: t
See note on back regarding River Basin t

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: G bov'4)_
Date: d 2 jc� �2o [-7
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. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(Ai
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
diE
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
re,
restoration or
and/or temp
restoration or
ter
ternimpacts)
impact amount)
ternimpacts)
an
l Z g-
l Z g
Dredge ❑ Fill ❑ Both ❑ Other 41
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

NCDE�IR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: (
p,'?J!
lame of Property Owner Applying for Permit: Name of Authorized -Agent for this project:
42�))�Ve_ G(,ict �J �ruL�ior'1
)wner's Mailing Address:
asW� .
#L/ 232-
'hone Number (r%�)
Agent's Mailing Address:
46 koo &61 0(- 6W
yc�xn Isle mach, -1V.0
p Xa%g
Phone Number ( /0 ) r51CF WRS7'
certify that I have authorized the agent listed above to act on my behalf, for the purpose d(applying
)r and obtaining all CAVA Permits necessary to inst II or construct the following (activity):
iJ /i ��
or my property located at /✓� �v�s� Z�
'his certification is valid thru (date) ±4/7
J.z�IG
_Property Owner Signature Date

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