39756D - Bosquet

CAMA Pr:DREDGE & FILL
GENERAL PERMIT Previous permit#
New Modification . JComplete Reissue ❑Partial Reissue Date previous permit issued
list
orized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7f�/Zv U
❑Rules attached.
nt Name C/a LC-- E:c!5 t/ef f/srf. oA) Project Location: County ru/ck:'
;s .t'-00 ' t2£ .::/ter cc 74 Street Address/State Road/Lot#(s) C f7GL. G
C 4%. ,1 /-5/c-- .3 c�C/i State /VC- ZIP 2 b'`ieo c/ -Ha r tj i- L.:cz< d
#(7/0)5'7 5- 2133 Fax#( ) Subdivision '7)70 r le /9c re-S
ized Agent City UGC. "'"' /5/C-- ZIP Z 8 A
d IIICW $W APTA ❑ L ES ❑PTS Phone# ( ) River Basin z "
is ❑OEA ❑HHF ElIH ❑UBA CJ N/A Adj.Wtr. Body fi fW'-4.-1 (nat
❑PWS: ❑FC:
yes / no PNA yes /(E) Crit.Hab. yes / no
Closest Maj.Wtr. Body /1'r'-'w)
of Project/Activity k%/G/'-/A)90/G G e. ' xI5hfrr j /J!e r
(Scale: /'
lock)length • S
/ lc. ?
— — 4 _-I.
•pier(s) l
-1- -1
length ._.__ ,A -
-
iumber
ead/Riprap length r lJ1/4:,e /3�'I L r
ivg distance offshore (Ye yee�
'flax distance offshore .
channel �1 ... r
:ubic yards „�5
r
.amp 1. 1 1
ouse/Boatlift i
l
V 'r-
Bulldozing �! y y 1/4✓ � r
f__ —_ _
lL' 4 t. V.i.
kii
line Length /(7V `% -� 77h'c
not sure yes no _ /G4.0
ags: not sure yes no /;. .' 1 {.�..
orium: n/a yes
s: yes L/
r Attached: yes -
ding permit may be required by: Bite/25/4)/C L Cc.t, ,"7 74/76/(j . =1 See note on back regarding River Basin

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: (--e-" U -
ADDITIONAL NAMES: t1/9 Po.i9
AEC DESIG: G Gv f DEVELOP AREA:__.DZ_ PROJ DESC: P -
Will only take 6) (Will only take 1)
WORK: Pie /
Will only take 4)
T� 30,/3
VIAINT:
Will only take 4)
[MP: a c) 39O
will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: ld2l-7 3/7/5
AMA MAJOR DEVEL REQUIRED: /2/7/oej 3/7/OS-

•
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Sign re
item 4 if Restricted Delivery is desired. y ❑
• Print your name and address on the reverse ��-(``'�_ 4
so that we can return the card to you. B. Receiv by(Printed Name) C. ate
• Attach this card to the back of the mailpiece,
or on the front if space permits. f m� ��el
D. Is d very address different from item 1? 0
1. Article Addressed to:
If YES,enter delivery address below:
6
j ,4,7 / / i/ .eC, 3. ervice Type-- ( Certified Mail ❑ Express Mail
L t—t--//e-6(,(_ Z4p v�� ❑ Registered ❑ Return Receipt for Me
8I t I • �Y 7 ❑ Insured Mail 0 C.O.D.
4d 4. Restricted Delivery?(Extra Fee) ❑
^• � 2. Article Number
Q
c
(Transferfromservicelabe 7003 1,680 0004 9798 0048
11141) PS Form 3811,August 2001 Domestic Return Receipt 10259E
i I
•
SENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
1 corn
l item 4 if Restricted Delivery is desired. �1 /�
';I
■ Print your name and address on the reverse X `' ❑'
V ' 41:414,11L
• (Dso that we can return the card to you. �A ❑
.a • Attach this card to the back of the mailpiece, B. -eceived by(Printed Name) C. Dat c
_. or on the front if space permits. (e{i /t f,
1. Article Addressed to: D. Is delivery address different from item 1? 0`i
Lil If YES,enter delivery address below: 0 N
ru
0
!• c /6.....„.„...„
, , D .
ik ,
oi)
/ 3./ , ,,,,,—, /6.2_, ,,
Ni. g . .,, 0_ , -- . Service Type,4, W z ru I e,L �� ,c \Certified Mail ❑ Express Mail
IBANIIIQ 6 -
� p Registered ❑ Return Receipt for Mert
W �-G � 0 Insured Mail 0 C.O.D.
-vwi rfl 4. Restricted Delivery?(Extra Fee)
2. Article Number El YE
r (Transfer from services 7003 1680 0004 9798 0055
O ru PS Form 3811,August 2001 Domestic Return Receipt
V 102595-c
L'1
C ru
vd u3dv5 alvJ1Yq M axn-Bo O ;d ma