Mitchell, Roy 76787C

XCAMA / ❑ DREDGE & FILL ` '" I 9 � c
A B
76787 CO D
GENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue []Partial Reissue Dat.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 p 0 s
Rules a ached.
Applicant Name Project Location: County � Z
Address � 7I , J Street Address/ State Road/ Lot #(s)
city —�5�' / StateV(,ZIP ©Lp�/(�
Phone # ) E-Mail
Authorized Agent ' ► t0'/'V ws L--Pw fe/1 C"'_
Affected ❑ CW W �-PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes Y/"') PNA yes ,t9n
Type of Project/ Activity
Pier (dock) length i
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore /
Basin, channel
cubic yards l
Boat ramp `
Boathou e/ Boatlif I %�13
r
/
Beach Bulldozing
Other S
r
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planningjurisdiction)A
Notes/ Special Conditions
V)omns LA-w-vepce-
plice or Apant Printed N ame
Signature ** Please read compliance statement on back of permit"
J7POO$ lei
Application Fee(s) Check #
Subdivision'j�7 "2q
City ZIP
Phone # ( ) River Basin N�
Adj. Wtr. Body nat a unkn
Closest Maj. Wtr. Body bulpn&
n/'
ir-rr
V
(Scale: 1 ::, A )
L'o I Y . ❑ See note on back regarding River Basin rules.
t � rt •-4— — ._I
��_A / Ij
e t
Permit Officer's Printe e
Signature
IN /ao
Iss ng ate xpir ion Date