78670A_Bekanich, Jason_20200630

A- /
& FILL N9 78670 B C D
9ENERAL PERMIT Previous permit #
:..:New ModificationCompfete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_..
�Aules attached.
Applicant Name,- )3- ... .. ....... ..
Address a0f , V (Zpcz
city" State-Aija- ZIP
Phone# (-I) E-Mail
Authorized Agent --1.,:1,,yJc,_
Affected , OCw JEW -/PTA ;,AS P, PTS
HHF 1H Ll USA N/A
AEC(s): ­OEA
Pws:
ORW: yes (nZi) PNA yes no
...................... ..... .
�A�gen or Applicant Printed Na,ie
X.......................
Sign, 44Pleaseread compliance statement on back of permit*
�11 �—�: I
Application Fee(s) Check
Project Location: County.L­c-
ae.^ ... .............. .. . .. . ... .... .. .......... ..... .
Street Address/ State Road/ Lot #(s)
M Mwmr-rf
City C--1*4e,-­­ ZIP -a , 7C 11-1 .... . ............................
nW�.
)..... ........................... RiAdjBody­� �-- ( �­+i:>-P, - it 11L.Vf/ -(n
Closest Maj. Wtr. Body

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ReA�"� ; C
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
y��ry mI92,l
Agent / Contractor
-7r, L
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in C E County.
/ furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information: Received
d GtS�f'1 Iy eA( en J� JUi 2 ) 20120
Signature DM
+►
�C�I EC
Print ffr Type Name
Title
L5 /mil a a 0
Date
This certification is valid through l l� / C?Ga

b/zb/1U1U
n
BASE MAPS
MAP LAYERS I
g)
�7
MAP TOOLS
(Q
SEARCH i
�) M„
F
PRINT
SHARE
O
HELP
/ROKMAPS_HE
ROKMAPST"
(httDSWWwv�
httnc-//mans.rnktanh.nPt/mkmanc ('nmciP.n/#
J r-je IT I
of i
r.
«*
'�
KUKMAI'S —
FIND
ZOOM BUFFER ADJOINERS VIEW PRC REPORT PIN DRAINDISTR E911_NUMBE ZONE
Zoom Buffer Find View PRC (prc.cfm? Propert 028943012632650000 Shiloh 204 VALLEY Rural
Adjoiners PIN=028943012632650000) Report RD Residentii