88812C - Smith, Todd

"❑CAMA ❑ DREDGE & FILL
3 GENERAL PERMIT
New ❑Modification ❑Complete Reissue [-]Partial Reissue
NI?88812 A s`c}D
Previous permit
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:
I SA NCAC 0-4 H 1) 0C) ❑ Rules attached. rv]/General Permit Rules available at the following link: wwwdeq_nc.gov/CAMArules
Applicant Name
Address `100 6(tS114VCI A6)--UJIS /_VI
P_A City 'Pl�l1 '?State /V ' zip 2 7(Po3
Phone#( ) 9/P� -' 53$1
Email <,rtn JIA VIAM11AroS. ( OAA
Affected ❑CW MEW ❑PTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW: yes ) PNA: yes42
Authorized Agent%!,-r Slm1 ,,?v�� tlf4 ��eP r
Project Location (County): rai ( k / C I y
Street Address/State Road/Lot #(s)5fq Kie)S%).) FI ✓e-
Subdivision
cityA41&y)),(. gegck zip 2V';17_
PIES
❑PTS
Adj. Wtr. Body t^"W1o�
(nat( unk)
❑ SPIMA
❑ PWS
Closest MaJ. Wtr. Body 1 >0Avl� P... C.. 10,1(
Type of Project/Activity w en11.1�9 -12J12e,-,I
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Access Length
Pier (dock) length
Platform(s)
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ENIONEINE
Finger pler(s)
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11111
Platform area
Groin length/#
Bulkhead/ Rlprap length
Avg distance offshore
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A building permit/zoning permit may be required by:
Permit Conditions No-G,11 N OeAdR4160
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) ----'ems
R"AoVS �hl6kVAe WA I
Agent or Applica nt PRI NTED Name PermltO 'cer's PRINTEQ Nems
Signature "Please r2ad compliance statement on back of permit*' Signature
Application Fee(s) Check N/Money order Issuing Date Ex iration bate