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Home My WebLink About69044D - ScottCAMA / ❑ DREDGE & FILL YIfNERAL PERMIT , ew ❑Modification ❑Complete Reissue El Partial Reissue PH 4,6,cti 69044 A Previous permit # Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources /1 ;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0-7 I� �a C� ❑ Rules attached. Name Je �� St O1' 4 M(A( � C Project Location: County A 41 3 0 L't C a Vy I 0'0' n E jr' � . Street Address/ State Road/ Lot #(s) �G,Vyy�4ji� StateZIP2 ZDI 'j LC4Vy►`rbv+(^ t ) IV - 7. J OS E-Mail:/� - Subdivision i—r�� :ed Agent tiY1 h 1y tyyrK\% city /�C O IS�( & kl % ZIP I l Li ❑ ICW [ W >fTA ❑ ES ❑ PTS ko o f ' 110) �•y ' �yq 7 Riv r Basin LV1M ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Cal O� (nat /1 ❑ PWS: L v � Closest Maj. Wtr. Body Al AVI yes / rCo 1 PNA yes / i V atform(s) It Xj a► Platform(s) 3ulldozing ne Length ^ , not sure yes >rium: n/a yes yes Attached: yes o ,n ling permit maybe required by: TOW O 0 (. 1 0 h5 t 2bI ---I DI---w � ❑ See note on back regarding River Basin r i ; / f ■ Complete items 1, 2, and 3. ■ Priht•your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. AA,rticle Addrreessssled to: 9 7 illifyrhrr Alk-d- /'�o�esrtc� SC 1� 95d�' A. Signat X0'/-�❑ Agent Addressee 13. eceived by (Print Name) Da of D ivery Rupn D. Is delivery address different from Rem 1? t'❑ Ye If YES, enter delivery address below: Ll-* Vq L'wAVAO,� 3. Service Type ❑ Priority Mail Express® II I IIIIII IIII III I II II I II IIII I II II I I III I I ❑ Adult Signature t R ❑ Registered Mail ❑ Adult Signature Restricted delivery ❑Registered Mall Restricted ❑ Certified Mail(P. ((:- ,<<,,..<, .y d Delivery 9590 9402 1661 6053 1750 85 ❑ Certified MaIORe>3tMcfed Db14 ❑ Return Receipt for n r , _. Delivery a.,x• Merchandise m Delivery ResMCAdbelili ' ❑ Signature ConfinnationTm 7 016 0 910 0002 1223 6073 Mail .w:,. - ❑ Signature Confirmation Insured Mail Fit35fiii930llvtiry" `. Restricted Delivery (over $500) PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Complete items 1, 2, and 3. A. Signature Print your name and address on the reverse ❑ Agent X .� so that we can return the card to you. l'-� ❑ Addre ■ Attach this card to the back of the mailpiece, B. Received byrinted \Name) C. DaJ4 of Prel or on the front if space permits. Article Addressed to: nn D. Is delivery addtess different from Rem 11 ❑ ftea If YES, enter delivery address below: ❑ No lot P 3. Service Type ❑ Priority Mail Expresse II I IIIIII III III I i II I II III I II IIII II II I I Adult RestActed Delivery o Res stayed Mail Restricted ❑ CertifiedAdult Mail® DRegistered 9590 9402 1661 6053 1750 92 ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise 2. Articlp Nttmhpr fTraricfpr fmm canrira rmhaa ❑Gellert m Delivery Restricted Delivery ❑ Signature Confirmations" 7 016 0 910 0002 1223 l 6080 I Restricted Delivery ❑ Signature Confirmation Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt N.O. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date 4-/- •,7 ?dame of Property Owner Applying for Permit: Mailing Address: t[ (!�y o to A I"0 U- R ql a J Zc1 Z�0 I certify that I have authorized (agent) _ _ - to act on my belialf; for the purpose of applying for and obtaining all C_kMA Permits necessary to install or construct (activity) , .. at (my property located at) - This certification is valid thru (date) Property Owner Signature /-�!1z°!7 Date ,f// z°/ 7 (d 1. N n ■ ■!.■■ MEN MOM mom ■ ■■■ ■ ■ n ME ■ ■ ■ mom ME ME ME ME in%■ ■■i ME MEN 47/1 , mom ■ENII ��■■■■■■■■■wmif� ammommommon