68014D - Vogler

LAMA / ❑ DREDGE & FILL H� JJ
iENERAL PERMIT��'�
New ❑Modification ❑Complete Reissue El Partial Reissue
A
Previous permit #
Date previous permit issued
B
ized by the State of North Carolina, Department of Environment and Natural Resources �] ^} SC a 0-7 1 � l 7a
',oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC I �' G Rules attache .
t Name G '� `�' Project Location: County(LV�� V'`7
r a (�. L V . Street Address/ State Road/ Lot (s)----�---
State ZIP T151 tf!, �Gt�6,k s `
0(0—'S49'E-Mail Subdivision
ed Agent `I t/t ct (✓� S City r �1i(t S( �j { �l( ZIP L
❑ CW W❑ ES ❑ PTS ' F'hon ( �d) J ' River Basin L ��
❑ OEA �HHF eTA
❑ UBA ❑ N/A Adj. Wtr. Body �6( 6'1 (nat /l
❑ PWS:
Closest Maj. Wtr. Body I An
yes / po) PNA yes /
f Project/ Act'vity IN I &I
'ck) length
atform(s)
Platform(s)
)ier(s)
;ngth--
Imber
i
Id/ Riprap length
g distance offshore
ax distance offshor
:hannel
i
Ibic yards
Imp
use/ Boat
W. f
WN NONE ENEI
I
t
G( L/'v
(Scale:
❑ See note on back regarding River Basin
1 I_ r -
. 1 ,.....I DL,.,.,;— I... icelir innl

NC Division of Coastal Mqt- Habitat impact Computer Sheet
Applicant: . V6 qoe*- �c S LL-C- Permit #:
Date: O-z- /, �,/7 old
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
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
a . ny anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge El Fill El Both [3 Other
Dredge n Fill [I Both 171 Other
Dredge rl Fill El Both 0 Other [I
Dredge [I Fill[] Both El Other El
Dredge ❑ Fill Ll Both [I Other 171
Dredge E] Fill ❑ Both ❑ Other El
Dredge[] Fill[] Both ❑ Other El
Dredge El Fill [I Both El Other El
Dredge ❑ Fill [I Both 0 Other 0
Dredge[] Fill El Both 171 Other 0
Dredge El Fill [I Both El Other El
Dredge[] Fill[] BothEl Other El
U.S. Postal Service'" U.S. Postal Service"
CERTIFIED MAILO RECEIPT CERTIFIED MAILP RECEIPT
Domes'tic Mail Only rr' Dome itic Mail Only
For delivery information, visit our website at www.usps.com`. _nFor delivery information, visit our website at www.usps.com "".
sur�T!tEJV A'
ar�tffied Mail Fee ru AIL U S E
$3 .30 047 0 ro Certified Mail Fee'
$3. 30 (147 C1

��► A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis
)vernor Director
John E. Skvarla,
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuHm
Date: 1t A S /I (o
ie of Property Owner Applying for Permit: eof Authorized Agent for this project:
6 -LER PR0Pt7RTI ZS t_ l__�tl�-mr, c ^ C s i-LL�k ,� ,-)-
ier's Mailing Address:
C I N Dy 46& L-E7Y2-
)Z O N SA R- D I_ M ,
-ie Number (°► 1q) Ll D Co — 54 8
Agent's Mailing Address:
Phone Number(
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or construct the following (activity):
LJ o 1 sue, 14
my property located at
certification is valid thru (date)
I
fLl
Property Owner Signature
t /-30 /1-7
Date

1