60719D - Davenport

AAMA / DREDGE & FILL +/ NO. 60
GENERAL PERMIT VV Previous permit #
i/New ❑Modification .Complete Reissue Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources +
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
;. ules attached.
nt Name Project Location: County CSC_.
sStreet Address/ State Road/ Lot #(s)
State NL ZIP Z �33Z (OC,2-0
0 ) Z 19-.'63L)A Fax # ( ) Subdivision
zedAgent e%L L ftfL — (1ji{ 1�� City tJ(�1L ��l,Pt I�i� ZIP
❑ CW [AW L PTA ❑ ES � PTS
El OEA = HHF -1H UBA ElN/A
❑ PWS: ❑ FC:
Phone # ( ) River Basin URIC
Adj. Wtr. Body )�A S {J Pc-l_ at
yes / �Sb�� PNA yes /� Crit.Hab. yes j�oi Closest Maj. Win Body �x Its
if Project/ Activity i j�.! �GUI� C E 5-rlt.lC, j tO f fJG V( Vz
(Scale:
ock) length_
m(s)
pier(s)
ength
umber
ad/ Riprap length
rg distance offshore
iax distance offshore
:hannel
ibic yards
mp
use/ Boatlift
3ulldozing
ing permit may be required by: 0
❑ See note on back regarding River Basin

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Pay
1 1 Top
51 K4 a4

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date O\
Name of
Property Owner Applying for Permit:
oeiiue^aAJ,
Mailing Address:
�� 16tv�d-iI a -
I certify that I have authorized (agent) 1i1 S ///2K/&-.e_toactonmy
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 1)700C
at (my property located at) 0 L 1 L.I.
This certification is valid thru (date) (J
FAWWrA�T/�
_(j I
Property Owner Signature
Date

C Division of Coastal Mgt. Habitat Impact Computer Sheet
►plicant: ,lfl�, Il^� 1 (��12 -{�-j� Permit #:
tte:
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
and in your Habitat code sheet.
ibitat 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 im acts)
FINAL Feet
(Anticipated fir
disturbance.
Excludes any
restoration an(
temp impact
amount)
n r�lJ
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 ❑

■ Complete items 1, 2, and 3. Also complete
A. Signature
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,
X
❑ Agent
❑ Addressee
B. Rece' ed by (Printed Name)
C. Date of Delivery
or on the front if space permits.
1. Article Addressed to:
D. Is delivery address different from item 1?
If YES, enter delivery address below:
❑ Yes
❑ No
2 E, /2 L emo-7T e e,: ,j
l7 r la fire AIL���
2
3. S ice Type
V 1 �' `tl
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) 7 010 3090 0003 7165 3843
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: WAK,
Dr-
qG
G
j/L i`���v✓oo� �I
27�,9��'°s
102595-02-M-1540
A. Signature
X /
❑Agent
❑ Addressee
B. Received by (Printed Name
C. Date
of Delivery
- )u 14— f- -,?-"
e
d < 4
D. Is delivery address different from item if
❑ Y s
If YES, enter delivery address below:
❑ No
2. Article Number 7 010 309
(Transfer from service label)
3. Seprice Type
9C rti ail El Express Mail
❑ to ❑ Return Receipt for Merchandise
Ins Mail ❑ C.O.D.
ted Delivery? (Extra Fee) ❑ Yes
O-VtO03 7165 3836
PS Form 3811, February 2004 Domestic Return Receipt 102595.02-M-1540