60615D - Maddox

'CAMA / DREDGE'& FILL' I NO. 60
GENERAL PERMIT Previous permit # 41,4-
-_iNew Modification Complete Reissue Partial Reissue Date previous permit issued_,
orized 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 071
Il 12Uc)
ttached
_ �u
nt Name z-� ne
,/J ,,4 jln,4 e)V
,J _ Project Location: CountYloin
s j9� Street Address/ State Road/ Lot #(s)
1V�P t'N State AIC ZIP Z,Ir' -7 : r ,
Fax # O Subdivision_
zed Agent gs"�.,f yN+ i h City ✓ ZIP-'
i ❑ cwW PTA ❑ ES ❑ PTS Phone # ( _) River Basin
❑ OEA /❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC: Adj. Wtr. Body Ovn at
yes no PNA f7y:esV no Crit.Hab. yes na Closest Maj. Wtr. Body
_ 7
f Project/ Activity
7 ra? /' Y .
)ck) length
!ngth
amber
d/ Riprap length
g distance offshore
uc distance offshore
cannel
)ic yards
-1p -
I
a Length l �b _..._...._
not sure yes no
not sure yes
um: n/a yes
yes no
,ttached: yes _ L
ig permit may be required by:,,�/�
r
(Scale: (fl;
F See note on back regarding River Basin ru

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A A-1. - ;-- A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date -- 71Z 2
Name of Property Owner Applying for Permit:
Mailing Address:
a
I certify that I have authorized (agent) -PC CT ( r �g to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) a_
at (my property located at) -70 � S j
This certification is valid thru (date)
`T-22-/Z
nu,,.o,.

Describe below the HABITAT disturbances for the application.
found in your Habitat code
All values should match the name,
sheet.
and units of
measurem
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Fee
Habitat Name DISTURB TYPE
(Applied for.
Disturbance total
(Anticipated final
disturbance.
(Applied for.
Disturbance
(Anticipated
Choose One
includes any
Excludes any
total includes
disturbance.
Excludes any
anticipated
restoration or
restoration
and/or temp
any anticipated
restoration or
restoration ar
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
/
W Dredge ❑ Fill ❑ Both ❑ Other
07 2—
COMPLETE
SECTION•
■ Complete items 1, 2, and 3. Also complete I A. A
at re
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse X I� Agent
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the mailpiece, �Received Printed Name) C. D j�f lv
or on the front if space permits. lIQlr
1. Article Addressed to: D. Is delivery address d' rent fromitem 11
1 j�
If YES, enter delivery address below: ❑ No
t t ✓1 t S e OzL-n p/C.,
Z05 5, R 1-1-, 1�
ge*,Ak 64
r 3. service Type
8 Certified Mail ❑ Express Mail
i O ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number ❑Yes
(Transfer from serviceiabe, 7011 2000 0002 2765 3606
PS For 3811, February2004 Domestic Return Receipt
102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
■ Complete items 1, 2, and 3. Also complete A. Sign ture
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you. B. Received by (Printed
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
❑ Agent
❑ Addressee
C. Date of Delivery
1. Article Addressed to: - I D. Is delivery address different from iterli 1? ❑ Yes
If YES, enter delivery address below: ❑ No
_i �: 't