17625D - Henry

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CAMA AND DREDGE AND FILL Q1(625-
GENERAL
-1�
PERMIT
0 as authorized by the State of North Carolina
Department of Environment, Health,and Natural Resources and the fi o tal Res urces Commission
H in an area of environmental concern pursuant to 15A NCAC / H. //Ov
Applicant Na �� CAP Phone Number
Address 6' 93 N W
L Zipa � o I
City 1�'���i State � p
Proj ct Location (C unty, S to Road,Water Body,Letc.)
1„ un S�' ` f /1 C 1 /C� (n PCc1Ll.
q���<<�i 1'c f yaw rs4.( it✓hS t_k Co .
Ty of Project Acti ity CoAy?r,v4' �J'rj('.y� G low S' ke O.$ IIw*1 it/'r J /i^ ( 4. /94(1 4.c,
�Cu^ Z . 4 ►v. 4fe" `I- ail ('ou)+uI u. ( A.. dS /41 (...NJ1 fions at r7N. 1/Oa
Au I( a', LI
PROJECT DESCRIPTION SKETCH (SCALENa4 ?; SGak }
Pier(dock)length
i
Groin length s' s L
�jt,rtiS +n e .61
e-nJ 'w --' _ *
number ;.-- 4
B he d length �� I-14(ur A �� } r
max.distance offshore 1"r i
� \ -�- ---
r l '
Basin,channel dimensions 6 0
cubic yards /f7 0 ' E .
Boat ramp dimensions
iI a_ - -1---.t--
Other t � 1
4r1" i
6
Ll � r7a' � � I
i 1 I
l(ie.0.... ' .. .
This permit is subject to compliance with this application, site /d/O/CA---.....„..„..,
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
applicant's signatur
imprisonment or civil action; and may cause the permit to be-
come null and void. �}
' C5.--f/L- ---1
This permit must be on the project site and accessible to the permit officer's signatur
permit officer when the project is inspected for compliance. -3..7/„ 9 Q 6 - 3� Q Tj
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local issuing date expiration dat
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no ri bi 1 /
objections to the proposed work. attachments

GENERAL PERMIT COMPUTER FORM
• APPLICANT NAME: EC) f� {n r
ADDITIONAL NAMES:
AEC DESIG: E S , C w DEVELOP AREA: .D.O S PROJ DESC: P -
(Will only take 6) (Will only take l)
WORK: P/-I /( :) , .�
(Will only take 4)
MAINT:
(Will only take 4)
IMP: S R 9, ^v C;
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: j - 3/_ /G Y 3 /��`-'7
CAMA MAJOR DEVEL REQUIRED: _ _

'' SENDER:
.o ■Complete items 1 and/or 2 for additional services. I also wish to receive the
rn •Complete items 3,4a,and 4b. following services(for an •
H •Print;ourr`name and address on the reverse of this form so that we can return this extra fee):
j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
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permit. I
■Write'Return Receipt ' mailpiece Re uestedon the below the article number.
w 42. 0 Restricted Delivery •
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P$Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt

c SENDER:
v •Complete items 1 and/or 2 for additional services. I also wish to receive the
m ■Complete items 3,4a,and 4b. following services(for an •
H •Print your name and address on the reverse of this form so that we can return this extra fee): -
card to you. 1
d •Attach this form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address •
permit.
, 'Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery 'j
Y ■The Return Receipt will show to whom the article was delivered and the date '
c delivered. Consult postmaster for fee.
v 3.Article Addressed to: 4a.Article N b
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PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt

r,; SENDER:
V •Complete items 1 and/or 2 for additional services. I also wish to receive the •
rn •Complete items 3,4a,and 4b. following services(for an
Q ■Prrindt;your name and address on the reverse of this form so that we can return this extra fee): e
j •Attach thisr form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address c
1) permit. a
at ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery '
« •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee. 5
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g 6.Signature: (Addresse yorAgent)
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PS Form 3811,December 1994 ��� 102595-97-B-0179 Domestic Return Receipt

s• SENDER:
p ■Complete items 1 and/or 2 for additional services. I also wish to receive the
rn •Complete items 3,4a,and 4b. following services(for an •
WWi ■Print your name and address on the reverse of this form so that we can return this extra fee): .
card to you.
d ■Atttac this form to the front of the mailpiece,or on the bads if space does not 1. El Addressee's Address 'i
permit.
y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery .c'
t •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee.
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v 3.Article Addressed to: 4a.Article Number
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PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt

SENDER:
o .Complete items 1 and/or 2 for additional services. I also wish to receive the
w ■Complete items 3,4a,and 4b. following services(for an '
C. •Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. a
ti •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 7
permit.
a, ■Write"Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery j
5 •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee. °
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O 3.Article Addressed// to: nn / 4a.Article Number a
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PS Form 3811, December 1994 102595-97-B-0179 Domestic Return Receipt