HomeMy WebLinkAbout28292D - Forbis cCAMA and DREDGE AND FILL
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G E N E R A L 2292��
PERMIT P 92ffI �c�
as authorized by the State of North Carolina
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 7 t . ' ! "U .
Applicant Name PI V,6 -\ u c b I S Phone Number
Address 5 2 0 -C�P)1 c-.) 12 a c1
City �-,ALle- �1.-c-,o', 1< <. State (\j(1-1 Zip _-)c�J-aV) '-
Project Location (County, State Road, Water Body, etc.) f tit'NSW t C i;-- c O._vM t. , 126 La r'\be-r1VA ,
;3 c`,,N t V\ -n - 1'\r•,L.', ,. Gr.s% ern A 1 `
Type of Project Activity '?c.c,lnc v e7C1`a#.1/\(\ k.)4i, \ .tr ri in mc.4fr - Pt .1cp n=-1\-A'
l f e !„te-c F--`,r,c' e xl ta4 1 /\Ci r,V,"' d a0C_1‹...... l/ 12'Y. 2:2 t 1
PROJECT DESCRIPTION SKETCH Mk i - 1 • Cift1*.A 1 (SCALE: 10T To )
wriiirmialiminimilialli111
Pier(dock)Length 4, o _
III 1I1I111 II
1
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Groin Length
number IIIII . L 1 ,
Bulkhead Length (1.,'") U I
max,distance offshore () I
III
Basin,channel dimensions III m
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_ _ 0 kill , , -,-
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cubic yards l : MN
Boat ramp dimensions 1111 . 1 iii gr.„ .ihm
Other iiqIIIiiIiiI1 ;
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This permit is subject to compliance with this application, site drawing �, / l��s�
and attachedgeneral and specific conditions.Anyviolation of these terms v �l `� �/ "
p -- plicant's signature
may subject the permittee to a fine, imprisonment or civil action; and --
may cause the permit to become null and void. `!l =
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This permit must be on the project site and accessible to the permit of- ` i permit officer's signature
ficer when the project is inspected for compliance. The applicant certi- 10 i I U 1 1 12 1 0 Z.,
fies by signing this permit that 1)this project is consistent with the local issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they '1 4-) . 1100
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project 1 1CO.
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is consistent with the North Carolina Coastal Management Program. application fee
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•ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
I Complete iter,le1, 2,and 3.Also complete A. Received by(Please Print Clead) Blate o D.•livery
item 4 if Restricted Delivery is desired. 0 r ) / _ 0 -6
I Print your name and address on the reverse
so that we can return the card to you. C. Sig :ur-
I Attach this card to the back of the mailpiece, X 0 Agent
or on the front if space permits. �/bi,•� /i • ` ,� • Addressee
,tirs delivery address different from item 1? 0 Yes
. Article Addressed to: If YES,enter delivery address below: 0 No
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`W I f �Il.�j , r+ V]/l Certified Mail ❑ Express Mail
21 3 0 Registered 0 Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
a �/4. Restricted Delivery?(Extra Fee) 0 Yes
Art Ou6�(CopO y f62 ry laOO d / O QO (1
'S Form 3811,July 11l9999,9 '�C//1 Domestic Return Receipt 102595-00-M-0952
UNITED STATES POSTAL SEI7 J L 4 F
PM 0 _ P .
21 SEP w
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• Sender: Please OW me, addres as nd ZIP—+-41T is box •
2l>2I i re Chi mn'eJ Ref Y.()
3i/y2P/td- /1/ 20193 /
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4.ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete iterns.1,2, and 3.Also complete A. a eived by(Please Print Clearly) B. Date of Deliver
item 4•if Restricted Delivery is desired. J Gam
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• Print your name and address on the reverse C. Si n. ure
so that we can return the card to you.
• Attach this card to the back of the mailpiece, X 'v "� Agent
or on the front if space permits. ❑Addresse
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: N°
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1 C 3 Service Type
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4. Restricted Delivery?(Extra Fee) ❑Yes
2. Art 6 per(CopYfrom servicoabel) 5 r g a 3 ae
PS Form 3811,July 1999 Domestic Return Receipt 102595-00-M-0952
UNITED STATES POSTAL SERVICE w I L First-Class Mail
P M Postage & Fees Paid
USPS
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• Sender: Please print your name, address, and ZIP+4 in this box •
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