64041D - Forehand

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CAMA / -DREDGE & FILL �,0a
iENERAL PERMIT
New ❑Modification ❑Complete Reissue ❑Partial Reissue
64
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources {1 /�-;,� 14
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Nam 1` /41P
lei L�fi1'-� State JVZ - Zlp-�'Wb 7
A Agent
❑ CW VfEW [1 PTA ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
n(?) PNA yes ot:Do Crit.Hab. yes no
Project/ Activity
LI lonerh
ElRules attached.
Project Location: County /�J- 1i lc
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP 2
Phone # (",} River Basin W
Adj. Wtr. Body ()1a;.4
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permit may be required by: ee note on back regarding River Basin ru

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'ECEIVE®
AUG 2 8
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N.C. DIVISION OF COASTAL MANAGEMENT
Date b
Name of ropert;
MailhMA ddress
o//
AGENT AUTHORIZATION FORM
Owner Applying for Permit:
07
NJ
ON `NOV",
%0Z8Z c y
(33A13
I certify I at I have authorized (agent)
to act on my
behalf, f r the purpose of applying for and obtaining all LAMA Permits necessary to
install or nstruct (activity)
at (my p4operty located at)
This certification is valid thru (date)
L� _-2
Date
Owner Signature

DIWSION OF COASTAL MANAGEMENT
A_ DJACEN7' RiP�1RU1N PROPERTY OWNER NOi1FlCATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
lh reby certify th8t 1 own PMP" adjacent to �rf,4 1-\ / O
Property tied at p (Name of Property Owner)
( ddress, Lott Block,
on c �c in ,ram Y P
N-C.
terbody) (Cityll'own and/or County)
Ag
MANAddress.
Ag;J1h
Hkeqd to me as shown below the develoP�ment heftm isandions to the proposal. ProPns+►rg at that location,
MAOM
avagabb
6
m
r DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENTA�`
4 proposing, dwekpment mus_f f Y in descdpdon below or attach a site drawing)
cft"tgwhatisbeftg ,Y*Um tno9ryfhenhi1ftnofCoastaf
Agmagenumt
9 wWL%1 i9 days or me*W d flits nofrcm Cmd,0 iaftmm Bon fQr MW fsis
dcmhdn ar by os/lin9 1408 /RCOAST. Nb
mkiered,ff a same
Owner kdotmatioo) ( 'an Information)
SOMA"
AO-W L
e Pm* or Type Name !
13x
Arming Addmss
, Nc 2 �Ho3