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PERMIT
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CAMA / REDGE & FILL No. 76357 A B c
ENE PERMIT Previous permit#
New ❑Mo ification ❑Complete Reissue ❑Partial Reissue Date revio sjperue"
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As autho ized by the State of Norch Carolina, Department of Environmental Quality ,and the Coastal Resources Commission in an area of a ironmental concern pursuant to 15A NCAChed.
Applicant Name Project Location: County
Address �7 Street Address/ State Road/ Lot #((s)
City n State ZIP j / )� I 1 / UnnVf AA
Phone # D c M-H Subdivision - j 11 n- /I n nor
Authorized Agent
El Cw
Affected
EA
AEC(s): ❑oElPWSWS
ORW: yes /
IEW PTA NES ❑PTS
HHF ON UBA ❑N/A
PNA yes
Type of Project/ Activity
Pier
Fixer
Float
Fingt
Groff
Bulkl
`—
Boat
Boat
Beat
Otht
Shor
SAV
Mon
Phot
Wain
City
Phone #
Adj. Wtr. Body_
Closest Maj. Wtr. Body
ZIP
Basin
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line Length
not sure yes
ks: yes
- Attached:yes no
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A building permit may be required by:
( NotenLocal Planning Jurisdiclr�a
❑ See nAte on Pack regardir7g River
09
Application Fee(s) Check#