59157D - Lee

:ICAMA / ❑ DREDGE & FILL
GENERAL PERMIT
]New ❑Modification []Complete Reissue El Partial Reissue
Previous permit #
Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources
71
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
-t
❑ R s a hed.
it Name e,
Project Location: County ..G�r /
❑' �l �
Street Address/ StatteeC,Road/ L/ot #(s)
lNa State ZIP 13
l C% rr/� I G' VA S !�
67` Z 0 Fax # ( )
Subdivis'n
zed Agent to '`'A--L—
City _ ' a r I ZIP '/0L
❑ CW �jjEw f PTA ❑ ES ❑ PTS
Phone # ( ) River Basin Gam/
j
❑ OEA ❑ HHF _ IH _ UBA ❑ N/A
Adj. Wtr. Body Gµ nat c
❑ PWS: ❑FC:
S Q
yes PNA yesjtjS` Crit.Hab. yes / no
Closest Maj. Wtr. Body
if Project/ Activity f-e 64C f le %ha
ock) length
m(s)1L
ength
umber
ad/ Riprap length
✓g distance offshore
iax distance offshore
.hannel
jbic yards
Lmp
'use/ Boatlift
Bul zing
ne Length
i
not sure
yes
,/' n2,�
gs: not sure
yes
nqf�
mum: n/a
yes
yes
415>
Attached:
yes
" no
s
(Scale: ! "' -
ling permit may be required by: Va Qi( U
-- - /A , e .A� ir%✓ ,
- ❑ See note 6% back regardingAiver Basin
r'._ 1 .CeeAi r/. � /J /r ✓ ,"

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gmegson, Director Dee Freeman, Secretary
Date Z - Z 3 , I Zr
Name of Property Owner Applying for Permit:
CCL'N1 i G L c
Mailing Address:
j � _ ,��Il� e�
I certify that I have authorized (agent) /7 �i I �-D t e 41CIt "l �y IlGi rr ne. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) t9 c Cj /( CFI /C C ,
at (my property located at) iC
This certification is valid thru (date) Q — -3 (" f )-
Property Owner Signature
Date

i V11-1DWIN Ur
k .L i✓'ELICY Rom PLAN- PROPERTY 0Y'T` ._..R' NOTI CATI i I -WI -A V FORM
a �-: �: e 3Y�F `�s1�$j+n• fi`ru_ Porn P't c*L✓h C/49
! e&,, of p_roF R I .)r-.
2 to
(-LCtOrsurd #, skretot
`L..t r and
:eb a ffy 9" a I awe. _ E c v�-$�i q r s �y_ the individual
�g�this pernfithas tome assuovmmOne atm&ed&''a�'g
-MPOsiR& A dwQtVd{m M a:s g, wfth s &Licid be s3ha` vdded -walL ri &
jBiief.
i
a -ter Cam$ ` a- Drive Axtandoia."W,f� ®�. i��2jW
v is ,-)T - '�' w as' ' y ��=. e�r S"�
r-,- ti"le ma
_.Y'� n "a�.
i'S�•w� _.aS' ".::stiiiC,�.`v1 1h�>
' m'�e uaiiit&Fl = Z etc �¢s i C
� esss rive4 in **he w'bac y Ye
k xe � 7� H.ritir.'
do i7ii-Lmh to W-nive the j 5' sed3A�-A �az�•t
Nam gate

f
ilicant:
3- �z
Permit #: 5-%'5
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
itat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
tem impacts
amount)
Dredge ❑ Fill ❑ Both ❑ Other
U
Dred a 171 Fill Both ❑ Other ❑
■ Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. X ❑ Agent
■ Print your name and address on the reverse i
essee
so that we can return the card to you. e, eceived by (Printed Name) C. at
elivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits. 1 / 2
1. Article Addressed to:
�J�sz14Z
cltrt4o, Ak- 2,3 329
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) ❑ Yes
2. Article Number
(Transfer from service labeQ 7 011 2000 0002 2765 7185
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-MAW
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
i X-