22439D - Montgomery

CAMA AND DREDGE AND FILL
GENERAL No 22439=D
PERMIT ")`"j"
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and theoastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 9 ti • 1100
Applicant Name � N 4 0 O 1 3 v f"\F Phone Number ''d
Address 'o2-OO 0 t `v'fN� 1 0 uk f 00 k_
City Ulj t 1,'h't r•\clA O r\ State IV`/ zip a541)3
Project Location (County, Statg Road,Water ody,etc.) f U r\SuJ t C_ C ou IN c , ( 1 CO
5 Kt«', 5 k A-to I ri F,-r. l...fl c k , QC.),
CJ, M - M nd C.A--n a
Type of Project Activity , �� -- ;,LAl iZ-- (I
PROJECT DESCRIPTION SKETCH (SCALE: Via-7 ( U )
Nk C evy- Nl�de A I
Pier(dock) length ^�
Groin length
number
t
Bulkhead length \TO
max.distance offshore SZ_
Cj m\-,t4.)
Basin,channel dimensions
cubic yards
PrePr°* it ,n1
Boat ramp dimensions il , pro pps!J
t Other y
6 u' Lu T
i
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any /��
violation of these terms may subject the permittee to a fine, !/�'1 '" 70 .-i/7---L applicant's signature
imprisonment or civil action; and may cause the permit to be (--pi,,, ,c ;-
come null and void. r/�^ U,�
This permit must be on the project site and accessible t' the
p� 1Rrt Offtrer's signature
permit officer when the project is inspected for complia \ �
The applicant certifies by signing this permit that 1) this pro- 0v..r 3 OQU l
ject is consistent with the local land use plan and all local issuing date expiration
iration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no 9 14 . 11 DO
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that A V I U�-
this project is consistent with the North Carolina Coastal application fee
Management Program.

GEE -PERMIT COMPUTER FORM
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-DREG€.FITT REQUIP, - 313 1 o 0 (2 13 ) d o
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SENDER: COMPLETE ThIIS SECTION COMPLETE THIS SECTION ON`bELIVERY
• Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Deliver
item4 if Restricted Delivery is desired.
• Print your name and address on the reverse C. Signature
so that we can return the card to you. ❑Agent
■ Attach this card to the back of the mailpiece, X ( ° fi. v'— 0 Address&
or on the front if space permits. J
D. I?delivery a• different from item 1? 0 Yes
1. Article Addressed to:
If YES,ente :slivery address below: 0 No
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3. Service Type
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X Certified Mail 0 Express Mail
i Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article N�heI opy from service label
Z / /ii' ((//DD
PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789

UNITED STATES POSTAL SERVIC � l.! F
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• Sender: Please print tir'�iaii , address, arid* IP+41rr'ttfis box •
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+ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2,and 3.Also complete A. Received by(Please Print Clearly) B� Date of Deliver
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you. Sign ture
• Attach this card to the back of the mailpiece, X A C JN9ent
or on the front if space permits. Addresse
D. Is livery address different from item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
41,
Y40//14Q....•
J 3. Service Type
�/ —'�( Certified Mail ❑ Express Mail
Registered 0 Return Receipt for Merchandisi
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
?. Article Number(Copy from service label)
Z. ;1 !vl4 � / O
'S Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789

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