10153-AH-GP71340-060718

❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑❑ 1 C �
To 71 A B CC, D
Previous permit #
Date previous permit issued
Applicant Name �% �rf' -c�tot �/ Project Location• County
Address
V
Phone #) e
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW:
vu/K
State/U(, ZIP
E-Mail
PNA yes /�'no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin Cchannel
cubic yards /0 0 0
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length � ���
SAV: not sure yes
Moratorium: n/a yes fa —
Photos: yes In r
Waiver Attached: yes 0
A building permit may be required by:
( Note Local Planning Jurisdictinn�
Notes/ Special Conditigns
Street Addrrss/State Road/oLot
Subdivision
City
❑ ES ❑ PTS Phone # ( )
❑ UBA ❑ N/A
Adj. Wtr. Body --A
Closest Maj. Wtr. Body
ZIP_
River Basin
nz�61
C� t ��,�- ❑See note on back regarding River Basin rules.
Agent or plicant Printed Na Permit
F**
Please read compliance statement on back o�rmit "
Fee(s) Check #