Wilson, Timothy & Rhonda 78204C

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/NDREDGE&FILL
EN ER/AL PERMI{
EModification Ko-pleteReissue nPartialReissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of concern PUrsuant to I5A NCAC
Project Location: County
N9 7S20-i
Previous permit *-?80tf O D
Date permit
Applicant Name
Phone # (_)
Authorized Agent
ORW: yes I
State P
_ PTS
-N/A
Street Address/ State Road/ Lot #(s) _ nl'5la*r,w""lfrSubdivision
ztP
BasiAffected qcw
AEC(s): troEA
I IPWS:
:fr'"
no
Phone # (
Adj. Wtr
Closest Maj. Wtr. Body
UES
II UBAHHF
PNA
Xease read compliance %
l-l S"" not" on regarding River
Type of ProjecU Activity
(Scale:W9 )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) r'-
Groin length
number
Bulkhead/ Riprap lengdr--
avg distance olfshore-
max distance offshore
-Basin, channel. ]
cubic yards
Boat ramp -------
Boathasd Boadift--
.-_-
Beach
Other
Shoreline Length
SAV: notsure
Moratorium: nla
Photos:
Waiver Attached:
yes
yes
)'es
yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/
Application Fee(s)
statementon backof
Check#lssui Date
D
Date
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NC Division of Coastal Management
Cashier,s Officiat neceifii "-'13799
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Date:
qc $
Check No.:
County:
Hd
Please retain receipt for your records as proof of payment for permit issued.
20ef,
Received From
Permit No.:
Applicant,s Name:
Project Address:
Signature of Agent or Applicant:
Signature of Field Representative:
Date:
Date:
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
r
Name of Property Owner Requesting permit:
Mailing Address:
DV
Phone Number:
C.2 sya
f,-) s q_s
EmailAddress:
I certify that I have authorized
Age
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
t
in
at my property located at
C ounty
I furthermore certif that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Locat Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application
Propefi Owner lnformation :
Print or Type Name
4
Title
]20
Date
This certification is valid through
I
Qt?1.
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