57456D - Surf

''CAMA / DREDGE & FILL M 6
ENERAL PERMIT / Previous permit# 421-
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
it Name / l G'w''� U Yr jf✓, TC c�r "� Project Location: County C* f�(�
k- /`! ✓,`° &41/ l L,fit fIJC Street,A/ddress/ State Road/ Lot #(s)
StateiVr ZIP .4s /,"
Fax # O Subdivision
ted Agent p-, City S"�" 7 L i ZIP
CW EW JPTA p ES ❑ PTS Phone # ( /0 )` S !F:;r7 River Basin `
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body t k 140 r/ /N ) .- ! " i
❑ PWS: ❑FC:
yes / no j PNA yes /� Crit.Hab. yes /® Closest Maj. Wtr. Body s��,� �`c
Project/ Activity (� S vi l rZ 7s
/ 1`14) L,-�4 A9�d A f
k) length
s)
length
number
!ea prap length
avg distance offshore
max distance offshore
,channel
cubic yards
ramp
louse/ Boatlik
i Bulldozing
line Length
not sure
yes
no
,ags: not sure
yes
no
:orium: n/a
yes
no
s:
yes
no
w Attached: yes no
(Scale: l/'!
Iding permit may be required by: �tir Z i ❑ See note on back regarding River Basin

.-2013 07:28 From:9103533276
30/2013 10;07 FAX
page: 1/1
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L.JtL)dj U;iuHL Ull CHVIlU )I I lei IL allu Ndl.Ufal
DM-slon of Coastal Mai ausiment
I;ichsei c. Easley, Governor james h. Gregson, Director 'Milliam G. Ross Jr., SecrelarJ
ame iff Pniv.)erty Owner Applying for Permit;
/ 01.
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er wat ave aut-horized (age -at) C*d jjqX y
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p-,-irpose of appl- - for arid obtaLring aE' -to
C-4- Permits necessary
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IDate

;ant ( t} C ✓ Q `� r '� vi Permit #:
ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
it 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
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
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 ❑ Both ❑ Other ❑

GLOBA. ]OMPIRM8811 North Am PAYABLE THROUGH ng Company, MN
wo��'�'�� 328252742
-CHECK #1 M.O.#328252742
432 04/02/13
2S;2C>C>DOLSC>C}CTS
TWO HUNDRED AND 00/100 DOLLARS
NOT VALID OVER ,�.'Y.;D DOLLARS $500.IV
CASHIER READ REVERSE SIDE BEFORE CASHING' �Y�
MONEY ORDER
`..DL GIFTCCERT RECEPIOENT