Loading...
HomeMy WebLinkAbout76231D - Pope1CAMA / ❑i DREDGE & FILL NO. 76231 O GENERAL PERMIT Previous permit # 1IN6w ❑Modification 11clorplete Reissue El Partial Reissue Date previous permit issued Cl As authorized by the State of North Carolina, Department of Environmental Quality —I h ,e �} and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC U ❑ Rules attached. L Applicant Name Project Location: Countyk� lI Address Street Address/ State Road/ Lot #(s) City State ZIP iAA Phone( _Mail Subdivision i Authorized Agent CityZIP ❑ Cw �4W �,[ PTA ❑ ES ❑ PTS Phone # ( ) River R--4- Attectea AY- C re#'�t. /r/��}p/plicant PPrrrii httejd/NNaam�ee Signature ** Please read compliance statement on back of permit Application Fee(s) Check # Printed Name r Sign-atu-7 ig17 Issui Expiration Date I DocuSign Envelope ID: F088F6F5-8771-4CC3-8C5C-824A65AA9AA5 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: 1 q-c�_ F� N(- Phom Number: L? `%(o Email Address: ' I certify that I have authorized 1:7 . Agent / Contractor to act on my behalf, for the purpose of applying for and obtaini V .afl.CAUA perXr b necessary for the following proposed development:--IXG�C� at my property located at _ / '-/g L h Gt u zrtk 94 �7 in -� County. l furthermore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal ,'Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. P operty Owner Information: Signature 0)�-�A/4 jh. k)ap� Print or Type Name �—� ji/— Title Date This certification is valid through / !!� Date R-1—d Data Deposited Check Fwn (Name) Name of Pa ft HoAdw Vendor Check Numbe Chock mwint Pa it NumbetJC—ft Relund/ReallocatedCe�MM9 Column2 Columm3 Co/wnaM C/wm6 CowmtM Column7 CllrnlB LRR—gintor Cak-9?l�J07O PFI Conebutlan LLC Robert Yours 001 water Street LLC Fden9 CU 7027 i 2CD.00 OP f74B00D CeMW Meakw Pleas BU"d.. a LLC Web F 23227 200.00 OP f7B77BD Cwohw B- y Sue rumor FWM Bnk 1419 100.00 GP nN72D _ Mr Pnersm Marine aM