76433D - True

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CAMA/ ❑DREDGE & FILL LECZ 9 c2'o2t jv Q
76433
aENERAL PERMIT Previous permit "7ss/3
INew XModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued (0/-2
sized by the State of North Carolina,Department of Environmental Quality
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC // i • 2 U
❑Rules attached.
:Name )e t'1 r f c 1 rLA >° Project Location: County 8rurIt,' ct
SAMe / / Street Address/State Road/Lo #(s) ,J State NL ZIP ; C�y(// i /a / in i'7#11^S D r
(110) 5yo ) ' E-Mail Subdivision ------" /J
ed Agent Iv' C C �- c o� Ma ►^k_ City C.)Ou- Gr4- ZIP ; !/1
❑CW 4W XPTA ❑ES ❑PTS Phone# ( River Basin CF/
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body PIA f-C.1i r/t A!'l 1f e et. JO
❑ PWS:
yes / �o PNA no Closest Maj.Wtr. Body /clic'
'Project/Activity j 1, ISD44i)T /-/! KT (oO o e r & +tiebiI\ c!a I
a- riling I rdex1 /1I/r tGf'Qa4-/1 IDC.1�- (Scale: I Tr-
:A)length /
itform(s) (�;
Cre,e,
ii 1 6
Platform(s) i '
Y
ngth / iittokl i
J
mber L _. -- i
J/Riprap length ,
distance offshore
x distance offsho i 1
cannel 1 n �„� `2X`��rL
Vn-
tu `
,,sicI ii rn,,,k s'e
yards i /
np
ft IZxIZ -- ✓ 1-
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ulldozing �/ p • — i I f
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riot awe" i t4 i l l
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e Length .*1- I I1 C.)‘ __ ---I'—�` 4-1(1 I,f' I k�``�+I 1 +-."r"
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not sure yes no ---— -
•cum: lnfa } yes no I r i
1.
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ildir-is ICI rU �u
Attached: yes
ng permit may be required by: , r VIA S 1.""I(-IC C&M See note on back regarding River Basin r
Local Planning lurisdictionl ., / /' f , i

LAMA/ L DREDGE & FILL No. 758I3`
A B 1
ENERAL PERMIT Previous permit# `is r ..:,
Jew 'Modification Complete Reissue L Partial Reissue Date previous permit issued 1 ' / '
:ed by the State of North Carolina,Department of Environmental Quality
,astal Resources Commission in an area of environmental concern pursuant to I SA NCAC
L i Rules attached.
Name � 1r1 jA pl. e. � r -- Project Location: County r I f�atc,
-� Street Address/State Road/Lot#(s) / 3 I6a,p f
State NC-ZIP r L -Drjv Q.
coo)_ d-6;0() E-Mail ./" Subdivision �''""
d Agent MAY"fok\ Mgr City cot p r4 ZIP V6
LI CW Li EW ' PTA ;€S ❑PTS Phone # ( ..--)'' *" River Basin C,F `,-
Li OEA LJ HHF ❑IH CJ UBA N/A Adj.Wtr. Body _ Ic2 f Lm
❑ P : ---
as no PNA no Closest Maj.Wtr. Body jk. td 3
SA4-LA(1 4 I
roject/ActivityI -�-- j/ '` j -
L, \ (Scale: 111 s !
:)length {_ r -±
t
form(s) — j t 4 r j — I
latform(s) _ f i
i i
1 r
f
I
th t j i i 1 i
{ _ ' 10 t ,
>�- I i I [_ #
R prap length - ! -+ -t - � t,� = �. — }
distance offshore t j t �_ 0�It i. \ _ j - - 1.
distance offsh e r 1 i , " I "�} � { i f
JJJ
nnel i i_ ��— A_ l- i I ; t i- f-
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c yard — ! ., `i _ ; j { r \rt'
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y$7
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Length �� �`�� 1�� ��. t-��- -�—���[ �_-) -� � � i
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not sure yes no i .i— 1{ ( — --_C — ' -i , fi f
im: Yes no Lt R4 ^� _ t I J ( 'L� l ( ) k�.. j }
*- �/ 1
es
ttached: yestop , ! _-.._
g permit may be required by: Y t.SC,SW\CY., `~'au ❑See note on back regarding River Basin rt.
.ocal Planning Jurisdiction), .. j r- I \ , , I

AGENT AUTHORIZATION FOR AMA Pp(T APPUCAJPON
Name of Property Owns Requesting Permit. Venni S 1W-6
Mailing Address: j V 3 I Capra i Ad �
S -f NC,
Phone Nurnoe t1 I u.54/v
Email Address:
I certify that I have authorized mC e4, rAI zyk r+ - vv.
Agenl!Cor>1raAor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development I - et a I I to4-4 1 rft'
at my property located at 1031 Oi I ' ka P"k
in ettlin5l �Lkk County
I furthermore certify that l am authorized to grant, and do in fact grant permissionb
Division of Coastal Management staff the Loch Pant*Oilier and IheIr agues b star
on the aforementioned lands In connection with evaluating itbrmation misted b hie
permit appticatror
Property O sr Informst,or.
'tedistritt.
Signature
�fr�iN i S ,
Print or Tips Name
2--a lL r 2C)

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