55836D - Rullman

VRMA / DREDGE & FILL �r
� c,
nIERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iriAcl by the State of North Carolina, Department of Environment and Natural Resources /
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ��7/ 1 �2DG
Rules attached.
it Name, w�e AW/ Rz Ae Project Location: County 4/ t A"- el'
-/52 j ,�G1 Street Address/ State Road/ Lot #(s) tyr
11i �l�ih� t�7 State ZIP_
254 6;76:7 Fax # ( ) �� Subdivision
:ed Agent �,�s� City S� ZIP
MAW L!KM P*fA ❑ ES ❑ PTS Phone # ( ) Sit l River Basin ;
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body �� lt/ na /
ElPWS: ❑ FC:
yes / no PNA<f�) Closest Maj. Wtr. Body
no Crit.Hab. yes / no ��++
F Project/ Activity � !7�lllj l�z-, e,1-'S r/ ti -- 1� / l�l Cf SS AD/t'r
,ck) length SIC 5 _
(Scale:
gttached: yes T—( 1 1' i I I I
ng permit may be required by: /(/� r(l% . /�fi1/� / ❑ See note on back regarding River Basin r
Special Conditions /if//< /�% �i /�� �iad/t/

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Fre
Governor Director Sec
AGENT AUTHORIZATION FORM
Date: 2'l0
Jame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
)wner's Mailing Address:
114L> � talv a u_--, 6o A
Phone Number (�lq d �^Z��
Agent's Mailing Address:
All 5
Phone Number (W) 6_ao *1-3 (�l
I 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):
(my property located) at
,Tbis certification ' valid thru (date)
l

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------ - ____------- ---- -- RECEIVED
DCM WILMINGTON, NC
AUG 0 3 2010
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DCM WILMINGTON, NC
AUG 0 3 2010
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3"
RECEIVED
OCM WILMINGTON, NC
AUG Q 3 2010
GruAet

MC.Divisi•on of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: YliI,, /x'S`J T��1 f �l Permit #: �59�
Date: M'fip
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat 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 f
disturbance.
Excludes any
restoration ar
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Othe
I—yq
Dredge ❑ Fill ❑ Both ❑ Other
jvd
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 0 Both ❑ Other ❑