Bozeman, Ken 80067C

% CAMA / DREDGE &FILL N +1. A B <0 D
GENERAL PERMIT Previous permit#
FJNevv Modification I )Complete Reissue Partial Reissue Date previous permit issuedW12/;ZLI
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 rt 7A1. ->
ftul attached.
Applicant Name �e) �%P.f OJQ Project Location: Counry�t;3 .__._
Address-_K,p5S�.��� inn Street Address/ State Road/ Lot #(s)_)-t � 5{ %
CiS+or� Sate ZIP 0 /a
Phone # (f) Q9-0' 1 E-Mail Subdivision___
Authorized Agent
Ale City —Affected El -
CW +-Vi- _44riA ,to ❑PTS Phone # ( ) _- River Basin / ✓'(�S __
—0TIH U ❑ SA O WA Body
AEC(s): OEA--aHHFAdj. Wtr. ���iP.e ��unkn man )
❑ PWS: Al ID`
ORW: yes / no PNA yes no Closest Maj. Wtr. Body / ��-yam-
Type of Project/ Activity
i I (Scale:
Pier (dock)length _ _
Fixed Platform(s) -lye—.LI/� I --
FbatlngPladorm(s)
Finger pkr(s)__
111
Groin length
number
Bulkheadf Riprap length
distance offshore�� ,�1}�
max distance offshore I V11� \.PA/%.Oj�.��...... _ /) i�
Basin. channel
cubic yards-r-�.-+- = •- .*--I. _: I {- ..-l. - -
�_xl3 ! t--7-I--!-'
L
Shoreline Length
SAV: notsure yes no
Moratorium: Iva yes no
t _ -
Photos: yes no
Waiver Attached: yes rw -
A building permit may be required by: CX
( Note Local Planningjunsdictio^r�L��
Notes/ Special Conditions �-it�/A
K, Po --
Agent-' ppyan�'PrintedfsMmy!J - _-
Si at " ase adcomplianca t�a(ementon backofpermitea
Application Fee(s) Check #
� r-_ ..-4_ -!
See note on back regarding River Basin rules
--
PermitOt<cer's Print�e��dJJ/Name
jD
Signat re
Ise n Dat E&pirati6n Date

CAMA / ❑ DREDGE & FILL " V� NO 80067 A B Q D
ENERAL PERMIT Previous permit#
[-]New ❑Modification ❑Complete 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 15A NCAC
�r �` Rule attached.
Applicant Name K e-n bn7pmG? fl Project Location: County l .n.C' I �'C
Address ,,� rlq�C•% VP Lgn (� Street Address/ State Road/ Lot #(s) t%
City �' o State" ZIP Doi 0
Phone # ) '� E-Mail Subdivision
i
Authorized Agent
Affected ElCW A �" ❑ PTS
AEC(s): ❑OFA ❑HHF ❑IH ❑UBA ❑WA
❑ PWS:
ORW: yes / no PNA yes no
Type of Project/ Activity
er
Fixed Platform()
Fined Platform(s) X
i
Floating Platform(s) �
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore�f
max distance offshore
Basin, channel
cubic
Boat ramp
M
Shoreline Length _0,2
SAV: not sure yes
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdictiort
Notes/ Special Conditions
ento p I' �ed'bo �I Name
Si ature •• Please read compliance statementon back of permit'r�'
Application Fee(s) Check #
City u✓ xf—i M c24 ZIP oZg.JlfO
Phone # () /� River Basin / V .Se-
Adj. Wtr. Body A MS� k man /unkn)
Closest Mal. Wtr. Body 1
(Scale: , j� )
I$ See note on back regarding River Basin rules.
�� (21 "11
Permit0(ficers Printed Nam
n 6J?
Signat re
a�i 9/elate
Iss ng Dat pirati n Date

0
m
NC Division of Coastal Management
Cashier's Official Receipt
Received From: I h-A ^'k -
Permit No.: re t$$I.tA OY G
Applicant's Name:
Project Address:
14181 A B(CD�D
Date: 20'?L_
aoa-L.
Check No.: �-l�
County: C
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
Signature of Field Representative: 14—
Date:
Date: 5gLA
RECEIVED
MAY 19 2021
DCM-MHD CITY