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
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/r/��}p/plicant PPrrrii httejd/NNaam�ee
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Printed Name
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Sign-atu-7
ig17
Issui
Expiration Date
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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
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Pa it NumbetJC—ft
Relund/ReallocatedCe�MM9
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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
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Mr Pnersm Marine
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