39354_STATELY PINES OWNERS ASSOC INC_20040726 (2)

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GENERAL PERMIT Previous permit #
N
RKew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued P11
A*orized by the $tate of North Carolina, Department of Environment and Natural Resources
an a Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ECAaes attached.
Applicant Name
Address Po'.
City, v fit► State N r ZIP �� 3
Phone # Fax #
Authorized Agent kO/t/.te;I—" F.-P
O CW lbw &�TA c PTS
Affected O OEA p HHF , O IH ❑ UBA ❑ N/A
AEC(s): , -.
o Pws O FC:
ORW: yes / (o PNA yes /(9 Crit. Hab. yes / no
Project Location: County C-rG ver\
Street Address/ State Road/ Lot #(s) rAp C �L
fl..-f G%inetZ--.fli,G /-27 Ak<CZ,
Subdivision --'r-4`" /Y
City_
e't-" zip
Phone # ( ) — River. Basin
Adj."Wtr. Body /y e,'^' 50/man /unknl
Closest Maj. Wtr. Body
Type of Project!Activity l0� � -� /Av4� 1 fry o f r, , p .f pc >. i 4W Lry
` / r
4 rd -rd pI ^� c/�/�� Pi/ �4 ✓cue n 1,�/,. ♦1 ✓Fief 6T<r j� (Scale:
Pier (dock) length _
Platfo
Finge
Groin
Bulkh
•
Basin,
Boat
Boat
Beac
Othe
Shor
SAM
Sand
Mo
Phot
Waiver flat e . yes n --
A building permit may be required by:
Notes/ Special Conditions Q 6, A c , --'L
r�. k. Ta�rno✓Q5f rj/ al -Ja inJ l�4 �/o.�- �nJ�✓ary �c L
e .Y-1 ti ��,•
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m(s)
t— _-!
Pier(s) J —
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e-
length — --------- -
umber
I -
ead/'Rij pray len h
-- -T
avg distance offshore _-' - L-- `
1� - -- I- --- -
max distance offshore r
N - --. -- —< -- -- - :
channel
cubic yards
p
ram s •. - - -- � -F--•- t I house/ Boatlift �n .� C� ": lC� : ' (Jr' .. ' , "G[(%!
h Bulldozing i -! - — -, - �ex
eline Length_— -- --r—'-
I
not sure yes
I
b es nv s: not sure
ritorium: n/ yes no-
os: yes (-no)--- -- —'
I 6�
A hd '
Agent or plicant Printed Name
ignature � Please read compliance statement on back of permit"
�, b `r
Application Fee(s) Check #
[] $ee note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name
Agent or plicant Printed Name
ignature � Please read compliance statement on back of permit"
�, b `r
Application Fee(s) Check #
[] $ee note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name