59207D - Culp

ICAMA / DREDGE & FILL
3ENER,AL PERMIT
Previous permit#
'New -Modification ❑Complete Reissue
❑Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
::oastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
.{
it Name ✓ I C G! ��'j
❑ Rules attached.
Project Location: County �GL✓�h!//r
2 110p ✓- :5 w e
Street Address/ State Road/ Lot #(s)
iV f State_ ZIP
t ( 0 2.114flil Fax # ( ) _
Subdivision
red Agent rl �►f,Y �D✓ �"%
City// %'" "yi 7�1>n ZIP 2
i C CW LH�W ;,PTA ES ❑ PTS
Phone # River Basin
❑ OEA ❑ HHF ❑ IH - UBA El N/A
tiW
Adj. Wtr. Body ^9Cin-r+✓yi 4y" �- ^ < (nate
❑ PWS: ❑ FC:
es no PNA yes / Crit.Hab.
yes noj Closest Maj. Wtr. Body
Project/ Activity
)ck) length
n(s)
)ier(s)
mgth
ember
id/ Riprap length_
Fg distance offshore
ax distance offshore
:hannel
ibic yards
mp
use/ Boatl
3ulldozing
ne Length ---
not sure y
gs: not sure y
mum: n/a y
y
Attached: y
ling permit may be required by: ('{ (y • -f Y16o6Lt .
- - i, l-. "bpi i_ J
P-0 1014( e eWs f
(Scale: / '�
❑ See note on back regarding River Basin

North Carolina Department of Environment ard Natural Resou
r^es
Division of coastal Management
James H. Gregson
Beverly Eaves Perdue
Gover,or
Director
Dee Freeman
Secretary
AGENT AUTHORI7ATIQN FORM
Rate:
Name of Authorized Ag Or this project.
N of Property Owner Ap lying for Permit: _
owner's Mailing Addre s:
r
----------------
Phone Number
Agent's Mailing Address: /
Phone Number y�O 31- -e 5/
1 certify that I havE: author' the agent listed above to act on my behalf, for the purpose of applying
Y Y)
for and obtaining sill CAMA Permits necessary to install o- construct the following (activit
tj 7�,„�Z(
(my property locryted) at
This certif+catior► is valid thru (dace)
V \ �<
Property Owner Signature
f
APR 0 3 2012
4 L241:2?,= DCM 'WILMINGTON,
NO
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Permit #: 5' 9? Z 0�
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat 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)
o1/V
Dredge ❑ Fill ❑ Both ❑ Other (
3 2
(3 2
ECEI Fill ❑ Both ❑ Other ❑
Fill ❑ Both ❑ Other ❑
E
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [IOther ❑
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 0 Fill ❑ Both ❑ Other ❑

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery i`s 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. Article Addressed to: I
/jcC) I JOVIC-05
❑ A<
Printed NargC . Date of
D. I slivery address d WrrrKem 11 ❑ Ye:
ES, enter delivery address below: ❑ No
RECE `
3. Service Type
❑ Certified Mail
C�4fjosd N �423'=R pt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from servi 7011 3500 0002 2560 5524
PS Form 3811, February 2004 Domestic Return Receipt
■ 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. Article Addressed to:
0-S00
F
APR
A Si �irfi
X /C ❑Agent
G� ❑ Addressee
eived by Prin d Name C. Date of Delivery
I M dress different from Rem 1 ? ❑ Yes
If YES, ent / Ibelow: ❑ No
AR 2 8 Z012 Oft
102595-02-M-1540
Mail QMVMs Mail
red ❑ Return Receipt for Mer
Mail ❑ C.O.D.
Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from service /abe 70141, 2 2 p T 5 517
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540