68063D - Hetrick

'CAMA / ❑ DREDGE & FILL AL �► Qrj�3,la,j7 8063 q g .
ENERAL PERMIT �t Previous permit #
lew ❑Modification ❑Complete Reissue El Partial Reissue Date prexwous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources r /
-oastal Resources Commission in an areaIf environmental concern pursuant to 15A NCAC O� �� . Z _ d ( 6714, j Z El Rules attached..
t Name V'fiYr �(_ VY) ( Project Location: County n 5 t,y; C K
t) %1-(, �j v 1 oe(tt StreetAddress/ State Rojid/ Lot #(s)(s)
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❑ OEA ❑ HH
❑ UBA ❑ N/A
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I O ig permit may be required by: wo o 5,o Y4 & o C ❑ See note on back regarding River Basin rt
-ocal Planning Jurisdiction) I ,

17/2012 09:16 9105799096 GRICI
0�,( S-a.r[ V i�6 r k �
'/LAMA / I DREDGE i FILL
C,�ENERAL PERMIT
)Pew I Modification I IComplece Reissue (Partial Reissue
thorized by the State of North Carohna, Department of Environment and Natura
he Coastal Resources Commission in an area environmental concern pursuant
Nan -we Nae &C I yT k &(i
"L K Prc
ress j D S D i �l i Stn
M�ouSa zlv 231
no # (' (� 11 I E-Mail _ Sut
-torized Agent r (�_�, //////-�� S k,-r, � /�Cir
cted I Cw � A ' FS i. PTs AIC
L_ OEA HHF IH ! i LORA I I WA
:(s): Adi
►Ws:
/
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V: yes / \ PNA yes / Clio
w of Project/ ActivkV
:r (dock) length / V
,ed Natform(s) !/ 1
i3v^g Platforms)
ger pler(s) _...- .. _
oin length
number
khead/ Riprap length
avg dstance olhhom
max distance offsh e
On. channel
cubic Yards
at ramp
athousd Boa
ramp
___, .._
ach Bulldozing
1
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wellne Length
I
v; not sure
yes —
watorium: n/a
yes
nos:
yes
rver Attached:
yes
wilding permit may be required b)r.
lots Local Planning jurisdiction)
A
en —
CON
PAGE
N° 68063 A B
Previous permit #
Dace previous permit issued
Resources
I SA NCAC
Rules attached.
ct Location: County GrV Y1 s 1M._ K..._...............
t Address/ State Ro Lot #(s)
PC) I
Ivislon
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TOwo Q Sl y GU-L See note on beck regarding River Basin i
19 1 ---1 11 ..- - A"7 l 1 C .A. . i . i l - .YI -

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ,12 Permit #:
Date: v
0Z-/(612Qc-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
FINAL feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Choose One
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other bg
`amount)
Dredge ❑ Fill ❑ Both ❑ Other
Postal
MAIL") RECEIPT
r,mestic Mail Only
�r delivery information, visit our website at www.uspsxomA.--
so.OV
t Services & Fees (check box, add fee P.o�te)
tatm Receipt (handcop» $
- • - -
tetum Receipt (electronic) $
:eMed Mail Restricted Delivery a d t t I —
Wult Slatature Recuked $
age
w.,
CDaits
MHCDO
Tyler Crumbley
LPO
*0.011
lervices & Fees (check bo

AGENT AUTHORIZATION FORM AGENT AU `HOR17ATIOIN FuRm
Name id -Property Owner Applying, for Permit.- Name of Authorized Agent for this pr(,P-,C+-
7'
Owner's Mailing Address.
Phone Number
Agent's Waiting Address.*
Phono Number te/n,
T__
1 certity that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Parmits, netes,,Hty togistall or construct the following (acfivity)-
I ; -,
'P, I �
j--,: ------
For my property located at
This Wrtift(�atton is valid thru (dalal
Property qwnler Signature
Date
A
t
�71
ill

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