60669D - Millsaps

LAMA /,K DREDGE & FILL
NO. 60
GENERAL PERMIT
Previous permit #
New ❑ Modification ❑ Complete Reissue ' Partial Reissue
Date previous permit issued
)rized 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,. a tic
Re-
Rules attached.
Project Location: County �1�VV'6wi (k
2S I&
flwof '
Street Address/ State Road/ Lot #(s)
`V
i(I hn`.�„ AItYYx StateIV�ZIP2':H(~
�2.2 May
lm' S IrU4
(::h4) rp- Fax # ( )
-
Subdivision N AA
ted Agient'a V 1 * Mf 1 I&Y-
s
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1 � 1) 6 tom. zip �
❑ CW ❑ EW ❑ PTA )6S ❑ PTS
1City11��l�y _.—
Phtne+# ) )-I -zi River Basin 1a1rn�
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
rr
Adj. Wtr. Body �t . (nat
❑ PWS: ❑ FC:
yes / no; PNA yes / no Crit.Hab. yes ro j
Closest Maj. Wtr. Body v
f Project/ Activity
)ck) length
.ngth r 1
amber
Ld/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
-np t , 1 _
ise/ Boatlift
lulldozing__
Sox IS
ie Length
not sure yes no �
s: not sure yes no
_..
rium: n/a / es no {t
Attached: yes no T
ing permit maybe required b:-I-fl Al il tf
_ - � Ali !!�n ,.,..1 �II ►J
(Scale: ' !
will 1 ❑ See note on back regarding River Basin i
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?ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. ^ ❑ Agent
■ Print your name and address on the reverse 6J ❑ Addressee
so that we can return the card to you. B. R ed by (PrirVed me) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different �i ?
1. Article Addressed to: If YES, enter delivery add r: _
In-444
/oy
/ 3. Service Type I*--�br �
❑ 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 servicelabeo 7010 3090 0003 7164 2595
PS Form 3811, February 2004 Domestic Return Receipt 102e95-02-M-iw
■ 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:
2
A. Signature
X / - ❑ Agent
❑ Addressee
B. Received by ( Printed Name) C. Date of Delivery
D. Is delivery address different from item 17 ❑ Yes
If YE,S,pq"--4 *pkaddrass below: ❑ No
11 1 .1111 �) � rm" an
3. Service Type
If'ted Mail Q afl
e$jsI red r Merchandise
❑ Insu C.O.D.
4. Resbicted De&ery? (Extra Fae) ❑ Yes
2. (Tticle ransfer
from
701,0 3090 0003 71,64 2588
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M.1540

Z-**AM
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor r Director Secretary
AGENT AUTF4OWATION FORM
Date: %
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
t�'ai%J
Owner's Mailing Address: n Agent's marling Address:
$a.S 6r'n f�)g w0cc
W),n s fv-y\ S IN (ev►. cee l'
Phone Number ?? S �!,J d Phone Number (W�
1 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):
16k eA
(my property located) at 42iay r h
/
This certification is valid thru (date)
---Property Owner Signature Date
127 Cardinal Dri'+a Ext., Wirni4on: NC 28405 We
Phone: W-M-72W PAX 9103953964 Noy/rth 9C/aroj/lffiTc`l
M ii- !CyPWOJVgtKT—at A`a EcCb/N Alat�tla ll/

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'pplicant: WY le
late: � l
/�l, llsuy s
.lZ
Permit #_ �O(P(,00fD
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
abitat Name DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill ❑ Both ❑ Other k
5�
Dredge ❑ Fill Both ❑ Other ❑�j
Dredge ❑ Fill Both ❑ Other ❑
O
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 ❑