84439C - Ross, Sue Fields

oNN°Fcoasrq` [ CAMA ❑DREDGE &FILL N 84439 A B (c� D
3 Previous permit -�
GENERAL PERMIT Date previous permit issued _Z
❑ New ❑ Modification A Complete Reissue ❑ Partial Reissue
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 i Rules attached. M General Permit Rules available at the following link: www.deq.nc.g_ov/CAMArules
l
Applicant me )() [+ I
Address �6 5 6
City 5�14NJ��(; 'State �1ZIP
Phone #
Email-
Authorized Agent
Project Location (County):
Street Address/State Road/Lot
/ #(s)
1 A V V�� � D
Subdivision,
City
P
Affected ❑ CW EW 'PTA ❑ ES ❑ PTS Adj. Wtr. Body i 1 t�� ��i(� /man/unk)
-�11—
AEC(s): ❑ OEA IHA UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body OE at) A
ORW yes no PNA: yes/ 'o) J►�
Type of Project/ Activity FL4�Lt t' i1 l-/A 5'l -Do wu
Shoreline Length -I'L
Access Length
Pier (dock) length I ► 1""�
Fixed PlatfgFm(s)
Floating Platform(s)
QD ,v _ lJ
Finger pier(s) two
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathous �ti
Beach Bul
Other
� 0 0
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: '� "���1" �/ ►(� �(
Permit Conditions
(Scale: 0/A )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
M AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
pplicant PRINTED Name
is PRIb(TED Name
Si ture **Please read compliance statement on back of permit** +�®
(-D I � a 110
Application Fee(s) Check #/Money Order
'3ignat re 4te; (7� a CZ
Issuing ate Expiration Date

GFanf1/ti t�fti�E � ; . 8 83
rILLr > A 8 t
Previous permit
E N E RAL PERMIT Date previous permit issued �
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
At authorired by t�_ taTf )atMiharoliaq. Department of Environmental Quality and th Coastal Resources Commission in an area of environmental concern pursuant to-
1 SA NCAC
❑ Rules attached. General Permit Rules available at the following link: .de .nC. ov CAMArule:
ApplicanM AA 0 Authorized Agent a
Addr s Project Location (County):
rAk
�4: 15 L,
City ._ State �{P_ — �J Street Address/State Road of #(s)
Phone
Email
City zIP,,_
Affected ❑ eW EW 4-TA ❑ ES ❑ PTS Adj. Wtr. Body nat/ an/unk
AEC(s): ❑ OEA IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: es no PNA: yes/
6�
Type of Project/ Activity 1 r 1 1/YIAV--inP 6.4 0 f
Shoreline Length _ 'j
Access Length
Pier (dock) lengths -
Fixed Platform(s) _C �
Floating Platform(s-3 Y, / to
�!
Finger pier(s)
Total Platform area
Groin length/#t
Bulkhead/ Riprap length
Avg distance offshore t
Breakwater/Sill `-
Max distance/ length
Basin, channel
Cubic yards
Boat ram
Beach
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos:
Riparian Waiver Attached. -
A building permit/ zon(i�g ermit r
PermilnConditions ]dt ft' 11.
(SCaIe
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional no s/conditions on back

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