54407D - Escoba

CAMA / ❑ DREDGE & FILL t; A
"ENERAL PERMIT Previous permit#
,New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources y�
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached
: Name t-'sC. - i'> ��+`i \-\D
Ln/
Statds'--J l/ ZIP 7_
Fax#()
:d Agent �~ ' t , r.I r
❑ CW f9 EW \:qOTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
(es (�D PNA &/ no Crit.Hab. yes / no
Project/ Activity Lf 1, , --)
k) length LI X 3,~ J
;s) j ,, � > x ) to
igth
nber
I/ Riprap length_
distance offshore-
( distance offshore
annel
is yards_
Ip
;e/ Boatlift
dldozing
i V-4- 1 y�
Length
not sure
yes
not sure
yes
um: n/a
yes
yes
attached:
yes
Project Location: County L"D �. 1
Street Address/ State Road/ Lot #(s)
Subdivision I "s 6, a
CityN I? A' S l- 6' 2 (L-U zlp 2-Sgti
Phone # ( ) River BasinW 1-t
Adj. Wtr. Body ✓✓�A�hr�..� S C, JL- - L (D; /n
Closest Maj. Wtr. Body 'y w 9-7T'/ 1=-4.-
77 ) X 1 �- L— ►A c-�->
(Scale:
ig permit may be required by: �-J N 5 �-� L'-Z' v- .-� - ❑ See note on back regarding River Basin ru

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Lil

A�7i�la
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director
Date
Name of Property Owner Applying for Permit:
Mailing Address:
•`I d 1 Rrnggkv—ve S5 l4-'L
G 2-g
William G. Ross Jr., Secretary
I certify that I have authorized (agent) ,c G iiy T/t - to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property Owner Signature
Date

1 PILINGS AND MORE
JOHN CASSIDY
PH: [phone] 5426
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460 �'C 66-30/531
457
Dateto the 1�o-oYde
Dollars a:..
® First Citizens
Bk
firrstcanitizzens.com Q P0447
For
I:053100300i:0045? 13 2?O 1 Xu'0S1,2C3

■ 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:
io" , C �d��S�� �✓
a/ 9 Q--)Il-vv JTf;lt,r
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A. Signature
X ❑ Agent
❑ Addressee
B. geceived by ( Printed Name) DaattQpf 4 very
4 ,4 ,�c Ct[! '(J
in
D. Is delivery address different from item 1? Yes
If YES, enter delivery address below: ❑ No
n n Sf" 'U" q9
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
(Transfer from service label) 7009 0960 0000 6028 6614
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ;
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
A. Signatu e
X `
Agent
❑ Addressee
Received by ( Printed Name)
C. D to of el* ery
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.
D. Is delivery address different from Rem 1?
If YES, enter delivery address below:
❑ Yes
❑ No
1. Article Addressed to:
,Q
. /
L�
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
C L OJ7
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number 7009 0960 0000 6028 6621
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540