89938A - Gebhart

FICAMA ❑ DREDGE & FILL �� N9 89938 A B C
GENERAL PERMIT Previous permit
3 Date previous permit issued
x❑ New ❑ Modification ❑ 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- i, il f Ur.,) ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdegnc.gov/CAMArules
Applicant Name
Address , ..
City '. State ZIP
Phone #(LI!'f)1
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Authorized
Project Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wen Body
Closest Maj. Wen Body
Type of Project/ Activity
(Scale:�
Ck—linu 1 matl.
Access Length
Pier(dock)length
•—--
--
-
! -
) -
,—
-
Fixed Platform(s)
t
_
Floating Platform(s)
Finger piers)
!
i..._
_. ��.
�;_
I__
_.
I
-_T
I
Total Platform area
le
_
}
_
1
!
V
Groin length/N
Bulkhead/Riprap length
--
L--
-1-
I—
—
-
-
Avg distance offshore
Breakwater/Sill
4
^
Max distance/length
�"—
"—
T
Q,
Basin, channelCubic
yardsBoat
rampi-
Boathouse/ Boatlift
Beach Bulldozing
Other
SAVobserved: Yes no
1
--
Moratorium: n/a yes no
I
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ 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) I 1 {
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check Jt/Money Order
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APP CATIQNS
Name of Property ryOwner Applying for Permit:
� --- -
Mailing address: .fi�
Telephone Number:
I certify that I have authorized ' �� 16''V (ayen&ontractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of
i X-14
t
at my property located atLs°
-A �-4 1,4'c
This certification is valid through
(Property Owner Information)
RECEIVED
signature
J U L 13 2023
Print or Type Name
co, owner or trustee for property
f�j>
Date
Telephone Number
(date).
56t". 2 Gcrszcs�SG ne i
Email Arlrlrccc

JUL. 13 M3
DGINA'

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