57583D - Rafferty

_ CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
New Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
iorized 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 r1 • j lU©
TrRules attached.
mt Name Project Location: County 6e0 N3W I CK
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ZIP
# 400 1 Fax # (—)
izedAgent— "{-_r? Jr A-iJ 1 N C'o
d ❑ CW _1 EW � PTA _ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no PNA yes / no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City 0 Me l SLA7V9 zip-7 fi
Phone # ( ) River Basin
Adj. Wtr. Body WLWTU_MC �J1 SLcx1�y
Closest Maj. Wtr. Body I W IAI
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length
iumber
.ad/ Riprap length
-vg distance offshore
nax distance offshore -
channel
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not sure yes
,gs: not sure yes �+►
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Attached: yes o
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ding permit may be required by:y%iK f S� ��'� ❑ See note on back regarding River Basin

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American Fish Company
P.O. Box 11046
Southport. North Carolina 28461
Email-- APC036000ao! cam
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Fixed �1cx
INVOICE NO #
(910) 457-548
(910)457-655

?.i1iF1S
Name of Individual Applying For Permit:
gdLuess of ProperrNl - -
f..or or Street 0, Street or Road)
"Ciry and County)
ZS
�,ereby certify tint I own property adjacent to the ahovc•refer"n e" are c-:-ti
appl)�Mg for this permit has d scrLbed CO me us shown an the 4t�►ct ee drawing The
are ptopoginQ. A desc,intion or drawing, with dimensions, should beprovid d with ethi
cA1,tcK '
1-%fr f,'--� I have no objections to tnis proposal
If you have objections to %viiut is being proposod, please ware riic Divsio
'�1aoaEement, 127 Cardinal Drive Extenjion, r n o;
Witbia 10 days of receipt of this notice, No response is considered 8�105 r'' call 4lg_
ti�ou have been norii{ed by Certined Moil, �c game a� n�, all
WAIVER SCCTIO:�.
I understand taut . pier, dock, m.00ringpilings, bronlovater, boatho"eor boaj4
bC-k&minimum distance of Ig' from my area of ripnri: n access - unless waL-vec� by
mi
"icb ` sive the serback, you must initial the appropriarc hla,-k belo,i rne
1 do wfshA waive the IS�seback rerauiremer+t-
I a'o ,n2 w'5h re waive tht 15 Suback rrttu,-czmtnt
3-10
un . smc
9a4e,
1 S a � ►-� iz
n-2__.,
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plicant: Permit #:
S� 5�3
te: L4118j I Z-
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
ind 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 fin.
disturbance.
Excludes any
restoration and,
temp impact
amount)
r
Dredge ❑ Fill ❑ Both ❑ Other F
2eK
30
O
Dredge ❑ Fill ❑ Both ❑ Other
95
8S
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 ❑