Groenenberg, Erik 800013C

^ YCAMA /Jb�bREDGE & FILL v " N9 80013 B /0' D
®GENERAL PERMIT Previous permit# t
❑New ❑Modification AComplete Reissue [-]Partial Reissue Date previous permit issued
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 I SA NCAC 0/ . OY �j +t/✓��
k
ules attached.
Applicant Name 'r C i Pca Project Location: County l�j Al/ 0
Address 9 ()1/0 1 11 /Am'A d Ct_ Street Address/ State Road/ Lot #(s) _^'�
City_ Nam✓-t-1 Statee&Pd Dj 0
Phone # (, E-Mail Subdivision
Authorized Agent
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AffectedEl CW " T 6W _,TA ❑ ES ElPTS
❑OEA ❑HHF ❑IH ❑UBA El N/A
AEC(s):
❑ PWS:
ORW: yes /0 PNA yes //00
Type of Project/ Activity
Pier (dock) length lc�
Fixed Platform(s) a�
Floating Platform(s)
Finger pier(s).........
Groin length
number
Bulkhead/Piprap length
avg distance offshore__
r
cubic yards ,`i
Boat ramp
Boathouse/ Boatlift
Beach Bulld zin
Other
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SAV: not sure yes o i—_-
Moratorium: n/a yes no
Photos:
Waiver Attached: no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
City ZIP
Phone# O River Basin 5e
Adj. Wtr. Body Fig
n man unkn
Closest Maj. Wtr. Body (' . r
(Scale: N/14
_PkSee note on back regarding River Basin rules.
Agent or pplic Printed Name ` Permit Officer's Printed Name
1 nature ** Please read compliance statement on back of permit** Signatur
Application Fee(s) theck# Issui gDat
Date

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0
CAMA X DREDGE IR FILL
NERAL PERMIT JAN 0 $ 2021
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