89065A - Donlan, Kevin and Teresa

le°"°""'&❑CAMA ❑DREDGE &FILL
N9'89065 ca; B C D
GENERAL PERMIT Previous permit
Date previous permit issued
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.naQov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ uW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length _
Access Length
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length - - - -
Avg distance offshore ------=-----
Breakwater/Sill---'-
Max distance/ lengtha.--`"
Basin, channel ,I .....,.-
Cubicyards I '
Boat ramp.
Boathouse/ Boatlift
Beach Bulldozing
Other L I—
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:
Permit Conditions
-
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ES ❑ PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
(Scale: )
❑ 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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on
permit** Signature
Check ft/Money Order Issuing Date
Application Feels
10 '/
Expiration Date

NX—OlViSIGN OF CoAsTAL MANAGEMENT
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