62535D - Wingate

(Scale: /
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CAMKi / DREDGE &FILL 1
GENERAL PERMIT
INew Modification []Complete Reissue ❑Partial Reissue
rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Previous permit #
Date previous permit issued
❑ Rules attached.
.nt Name i/WJ (,(,1,f AY, A TE> Project Location: County
s _ I
���ii%fie' .
Street Address/ State Road/ Lot #(s)
State Pe ZIP Z 60
S A / 1
/
# ( I} Z/S V# O
Subdivision
ized Agent
,rFax
/PA H ����'�
City .�Y►�A
�S � /�
ZIP
❑ CW
d
LAEW ''PrPTA El ES ElPTS
Phone # f ld
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�6 2�i River Basin d'1!///N
OEA
_
� ;HHF ❑ ❑ [-IIH UBA N/A
Adj. Wtr. Body
i
���'a/-
PWS:
yes / no
❑ FC:
PNA yes / no Crit.Hab. yes / (0
Closest Maj. Wtr. Bodyz.
)f Project/ Activity r
ock) length
m(s)
pier(s)
length
umber
:ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
w>oatlift
Bulldozing
ne Length _
not sure
yes
gs: not sure
yes
>rium: n/a
yes
•
yes
i
Attached:
yes I
ling permit may be re

Dplicant: r �A- N iJ G`f A�—i� Permit #:
ate: Z S 6 Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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 ❑ Oth
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
::::Dredgel 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 ❑

0INIST
#1
25/13
. PAYABLE THROUGH 75-1555
North American Banking Company, MN — i
331440995
M.O . #331440995
W;-.- LSQ+C] CTS
TWO HUNDRED AND 00/100 DOLLARS
70033 L44099Sill

W,ilrjo

AMI;A,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: 7 7
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
i E
Owner's Mailing Address: z�y�
Phone Number (q 4) 3 Z7- 1 ?—Z-
Agent's Mailing Address:
/ C_
Phone Number( 91,1) of 76- c5-y 7P
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my Property located) at %1 �� i"��/'" `f'��c c%, �/ / E/Ciy C oR yl..
This certification is valid thru (date) . 7
—�- r ��� K��o i7 TC� 1Z

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print 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. Articl�lressed to:
av/7
A. Signature
X ❑ Agent
❑ Addressee
B. Rn'lywl
Printed N e C. Date of Delivery
w
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) Cl Yes
2. Article Number
(Transfer from service label) 7 012 2920 0001 3991 1348
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired------
■ Print your name and address oh -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. Article Addressed to:
✓� �V N�J�T(i G
of iawro
❑ Agent
❑ Addressee
B coed (Printed am C. Date of Delivery
D. Is delivery adqPdss different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
/j' 3. Service Type
V r /J y`v✓/� _ ❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
7012 2920 0001 3991 1355
Domestic Return Receipt 102595-02-M-1540