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eCAMA / ;;-DREDGE & FILL S«
PERMIT Previous permit #
New�ERAL Mod`ication E''Com fete Reissue Partial Reissue Date previous permit issued
P P
irized 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
r�
❑Rules attached.
it Name AP7 YlOjr, Project Location: County_
3;? f 94hSiGY' jYle - Street Address/ State Road/ Lot #(s)
AJ1*1941Msr1,001 State Jib ZIP
t (i')_� A I_ Fax # ( ) Subdivision
ted Agent TA" _ City ZIP
Y1C'1W p�W E&KA ES ❑ PTS Phone # ( ) River Basin —
OEA ❑ HHF ❑ IH UBA El N/A
-- - Adj. Wtr. Body
PWS: ❑ FC:
yes / PNA / no Crit.Hab. yes / no Closest Maj. Wtr. Body
es/�-
f Project/ Activity C t4t /^-7 F e
<<
(Scale:
)ck) length 7,5 X
)ier(s)(110
-
-
__
-
-
----
-
--j
i
ember
id/ Riprap length
-
j
,g distance offshore
ax distance offshore
hannel
r
f
I
,
AI
ibic yards
mP
-
—
use/ Boatlift
I
iulldozin
L
I
,
i
'
._ .
I
�e Length.
-_ _
_
i
�---I-
not sure yes no
s not sure es
g : y
I
rium: n/a yes
yesi_—
11
_
Attached: yes -.--
-
ling permit may be required by:
�a , %j}g'�'!�
T,�/!+ ❑ See note on back regarding River Basin r

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
licant' - � D (r�n �d✓"t 3a
p Lr
ate:
�0/2k Ili
,scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fin
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
ibitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
1 Dredge ❑ Fill ❑ Both ❑ Other [ 3I-
■ Complete items 1, 2, and 3. Also complete
A. Sig ure w
item 4 if Restricted Delivery is desired.
■ Print yotrr name and address on the reverse
X
so that we can return the card to you.
ressee
■ Attach this card to the back of the mailpiece,
or the
B. R ew d y (Printed Nam)
Dat�of %livery
on front if space permits.
// I
1. Article Addressed to:
D. Is delivery address different from item 1? ❑ Yes
M RS . �.lrt►JS
If YES, enter delivery address below:
)W No
3z�{ 0AY5m9-t. DR
{ �+
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 1009 (transfer from service label)
2250 0 0 01 9573 2660
PS Form 3811, February 2004 Domestic Return Receipt
Dredge LJ rril U notn u vuici ,�
to2sss-o2-M-tsao
Dredge ❑SENDER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 3. Also complete a
Dredge ❑ item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse X
Dredge ❑ 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:
D. Is deriv address different fror
If YE enter delivery address