67957D - Salone

CAMA / DREDGE & FILL Y '1 Ir'
1`-, A B
Previous permit #
iENERAL PERMIT
New ❑Modification Complete Reissue El Partial Reissue Date previous permit issued=
ized by the State of North Carolina, Department of Environment and Natural Resources (�(
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC %� r' z C) 0
❑ Rules attached.
Name pp� V)
6-1
1 ;�I nO-afen State eJ ZIP—70
E-Mail — ---
,3d Agent G' 4ti iyk S A /� a ,� r"C
❑ CW EW I(PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
Project Location: County K
Street Address/ State Road/ Lot #(s)
Subdivision
City s h a I 10 --C zlP "L � y'
Phone # ( ) r LRiver Basin (rV M
Adj. Wtr. Body ] }
Closest Maj. Wtr. Body 'Al
yes / o PNA y6s / no
' Project/ Activity ('D 0 C kv (Q&io A2t-C/V- 0, i \ C n�� c f t �, �iZ;
, ? I R it -.{--t , v l.v^ (Scale: <
ck) length_`�� yI�%i
atform(s) (tG
Platform(s) I
ngth
mber
d/ Riprap length_
g distance offshore
ax distance offsho)
hannel
bic yards_
-np
.ise/ Boatlift
lul
ie Length fi� —�
not sure yes ro
rium: n/a yes
esno
��—�
Attached: yes(('' i
ling permit may be required by: �1 No >v� 1 i 1 C OVtiI � V 1,
❑ See note on back regarding River Basin
1 ­1 Pinni— Iurierlirtinn)

MC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �,QD✓l�(, Permit #: -7 �5 7-
Date: `z-��/Z��
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied. for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts.)
I FINAL Feet
(Anticipated fina
disturbance.
Excludes any
restoration and/c
temp impact
amount
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 ❑ Fill ❑ Both ❑ Other ❑
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 ❑ Fill ❑ Both Other ❑
Dredge ❑ Fill 0 Both ❑ Other 0

Payment Proccessing Confirmation
Date Received 12/9/2016
Check From (Name) Carolina Lifts Inc
=3
Name of Permit Holder Paul Salone
Vendor
Check Number
Check amount
Multiple Permits
Major/Minor
CresCom Bank
1129
$200.00
No
Permit Number/Comments GP 67957D
Receipt or Refund/Reallocated SF3481D