Harrell, Bill 78852C

lC / �REDGE & FILL ND 78852 A B O D
ERAL PERMIT Previous permit #
e ❑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 02-ig
n _ I 1 les attached.
Applicant Name yV� 1 (� l� i` Project Location: County„
Address 14/17 MAWOV �f) V'L Street Address/ State Road/ Lot #(s) / ®6
City R/x�Y.tq� / State�GZIPo27606
Phone #
E-Mail
Authorized Agent U A V I A h ndE -tVV7
Affected ❑ CW *W -kPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes no PNA yes
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)�
Finger pier(s)
Groin length
number
Bulkhead/ Nprap length
avg distance offshore
max distance offshore
Basin, channel i
cubic
Boat ramp
Boathouse/
Beach Bulldozing
Other
i
l
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes nog
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions.IR/
-71 JJow,") A 0)6 - n
e t or Applicant Printed Name
Subdivision
Clty Ne �c�� zip tgg5l'�
Phone # ( ) � River Basin (V/llfe-
Adj. Wtr. Body (nat unkn
Closest Maj. Wtr. Body
(Scale:'
❑ See note on back regarding River Basin rules.
Signa pre /
hl
Iss ingD to xpira on Date
Signature ** Please read compliance statement on back of permit**
W 71
Application Fee(s) Check #

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ILL
Mailing Address: aaA03
Phone Number:
Email Address:
i2ale.� Nc, a-)
Cg IC6� lg cj cl.�9
I certify that I have authorizedson
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
F load; ,
at my property located at _j b
in (ar kcrl- County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
0l 10`-) 1 �l
Date
C,� 3ti�9
RECEIVED
This certification is valid through I I
FEB 12 2021
DCM-MHD CITY

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Tracking Number: 70190160000017772196 Remove X
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Your item was delivered to an individual at the address at 11:50 am on
January 16, 2021 in MOREHEAD CITY, NC 28557.
OV Delivered
January 16, 2021 at 11:50 am
Delivered, Left with Individual
MOREHEAD CITY, NC 28557
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FFB 12 2n'j

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