Scott, Jim 78829C

,e4CAMA / ❑ DREDGE & FILL V Na 78829 A B © D
GENERAL PERMIT Previouspermit# fC
❑New ❑Modification -*omplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality . /n qcc�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �-
Applicant Name LO Rules attached.
Project Location: County onsto(t/
Address 903 nI Vi (L SAap-S p 6 VP- Street Address/ State Road/ Lot #(s) %
City State AtCZIP
Phone # (�) �E_MaiL Subdivision
Authorized Agent oe7 11�,.��,U_i o� City
AEC($): ❑OEA ❑HHF ❑IH ❑UBA ❑N/AAdj. WtY. Bod
Affected ❑CW � �TA DES ❑PTS Phone# 4Body
❑ PWS:ORW:
yes / o PNA yes noClosest Maj. W
Type of Project/ Activity C'
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
r
Finger pier($)
Groin length
number
11
--11
Bulkhead/ Riprap length
- -
-
avg distance offshore
_
max distance offshore-
Basin, channel'-
cubic yards
�
I
Boat ram
Boathouse/ oatlift X
�
-
�-
1—
Beach Bulldozing
T
Other 5
Shoreline Length n 11_
SAV: not sure yes
Moratorium: n/a yes o
Photos: �yes V _
Waiver Attached: no
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions
(Scale:
❑ See note on back regarding River Basin rules.
�s►� ��s�P� FOA c
•* Please read compliance statement on back of permit 'r'r Signat re
�0�10 17,/���
Fee(s) Check # Issy ngng D e xpirati n Date

AGENT AUTHORI7ATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: i 1 1 1
Mailing Address:
Phone Number:
Email Address:
1 certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: a)t
at my property located at I I !
in ��%�County.
C
1 furthermore certify that I 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 Or Information:
,m(-C)�t
Print or Type Name
}� Title
Date
This certification is valid through
kC ew
Giv - T I35C
Pd sa00
(A*- a 130
RECEIVED
JAN 11 2021
DCM-MHD CITY