69111D - Mabry

CAMA i4 DREDGE & FILL
A B
1EN ERAL PFERMIT
Previous permit #
New CJModification Complete Reissue ❑Partial Reissue Date previous permit issued i r Z
ized by the State of North Carolina, Department of Environment and Natural Resources L
i �II
',oastal Resources Commission in an area of environmental concern
pursuant to 15A NCAC 1
Rules attached.
NameJA� l ' S MAV y J,
Project Location: County AJP f.ti i /a i ltwo f
C ! u t G , S4 .
Street Address/ State Road/ Lot #(s) ! Suy t (Gf J
I(I iUf�Y1 StateS ZIP,Z U
if i'1 klcG(G
I'
703 E-Mail
ed AgentT:I. p C9l ! lilii'1
Subdivision
City �i t `u Yl U ZIP z PL ,
❑ CW ❑ EW ❑ PTA )(] ES ] PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
Phone # ( ))J River Basin
❑ OEA
Adj. Wtr. Body f�lf hj �✓�t/!�� -' (nary/i
ElPWS:
Closest Maj. Wtr. Bod�' (d dK S w Lt
�
J- / no PNA ye15L
f Project/ Activity t u)n) �C r` ill 1 fib 1�%
I41/(�(.� 'l
)Lt i r kla d 2 t FV6 fGt
ItiVA 4114 Uy 4—
(Scale:
,ck) length,
atform(s) '
Platform(s)
:ngth
ember
Id/ Riprap length G'T
g distance offshore
ax distance offshore
hannel,
ibic yards
mp 1
use/ Boatlift
NEI
�+. �ii1■ I■®■� ■■I
FRI
❑ See note on back regarding River Basin

;AMA /❑ DREDGE & FILL I a/i3�+ 4 A B C
ENERAL PERMIT Previous permit #
Jew ❑ Modification ❑ Complete Reissue []Partial Reissue Date previous permit issued
ed by the State of North Carolina, Department of Environment and Natural Resources
astal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached.
Name a '' Project Location: County w .,
Street Address/ State Road/ Lot #(s)
State ZIP $_,
2Q %`- E-Mail Subdivision
d Agent `r"=,) ,, City ryl ZIP 23qL
❑ CW ❑ EW ❑ PTA 6 ES OPTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ WA
❑ PWS:
eO no PNA yes / no
Phone # ( ) 4 Rwep Basin
Adj. Wtr. Body �i!'
Closest Maj. Wtr. Body
Project/ Activity
(Scale: (' -�
k) length
tform(s)
'latform(s)
ar(s)
igth
iber
/ Riprap length
distance offshore
K distance offshore
annel
iic yards
ip
se/ Boatlift
Aldozing
e Length
not sure yes n!q
lum: n/a yes no
Attached:
ing permit may be required by:
I_ncal Plannine lurisdiction)
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt, Habitat Impact C+amputer ShGet
Applicant: J �(,(bl� Permit * llC 11 j I
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.
NAL Feet
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq, Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tem impacts)
FIN)
(AnO
dis
E%
re
an
imps
- I
Y"
Dredge ❑
Fill
Both ❑
Other ❑
'2-0 0
Dredge ❑
Fill ❑
Both ❑
Other
D
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 ❑
Fi[I ❑
Both ❑
Other ❑
Dredge ❑
Fill.❑
Both ❑
Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other Q
Dredge ❑ Fill ❑ Both Q Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
�L Sq. Ft,
TOTAL Feet
for.
(Anticipated final
(Anticipated
;ipated final
[urbane.
(Applied
Disturbance
disturbance,
lodes any
total includes.
Excludes any
and/or
5bration _
any anticipated
restoration
temp impact
ilortemp
of amount)
restoration or
tem impacts
amounQ

h
2'
d�'7
1
0
o�o
I
vp./ ZVCj