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.IEENSRAL PERMIT
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pnao,: yes
Waiver Attached` yes
A building peranit may be requked 6y: r `f ` ,Y�t-. K C A. j/p7--7'- f' 4 See note/p� n back regardiing River Basat rules.
( Note Local Plannngf urisdictloa) Cl r. i n ti. � ., , r j :f 1 i �% ! Y "s J! t .: „�.
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CAMA / )(DREDGE & FILL Na 76745 A B C D
ENERAL PERMIT Previous permit#
®[]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous ermit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an af environmental concern pursuant to 15A NCAC
rea
Applicant Name Project Location: County
Address )nu: ' A0 h A A Al V Street Address/ State Road/ Lot #(s)
City
1
\
State(_
Phone #
E-Mail
Authorized Agent
❑CW ❑Ew
PTA ❑
Affected
AEC(s): 710EA ❑ HHF
❑ IH U A
❑ PW
ORW: yes / PNA
yes
Type of Project/ Activity
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier($)
Groin length
tuber
ulk a Riprap length
avg distance offsho -6
max distance offshore(,
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boadift
Beach
Other
Shoreline LengthI
_
SAV: not s
Moratorium: Photos: Waiver Attached: ---
A building permit may be required by:
( Note Local Planning Jurisdiction) a
or
See note on back
River Basin rules.
Signt Pleas ad compliance statementon back
--�pli{'d�t ** GI
Signature
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Appli[oFee(s) Check# Issuing
Date