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HomeMy WebLinkAbout76101D - SampleCAMA / X;DREDGE & FILL No. 76101 'qA I iENERAL PERMIT Previous permit # r rdew []Modification Cmplete Reissue ❑Partial Reissue Date previous permit issued zed by the State of N-. - C2rrolina, Department of Environmental Quality �astal Resources Commission in an area f environme tal concern pursuant to 15A NCAC ❑Rules ched. Name l6a i C Vw C�1 Project Location: County F p woo Street Address/ State Road/lot #(s) State���jP� ��� E-Mail Subdivisioni L AAgent NJ f C City t ZIPS ElCW CHEW C,PTA [US ❑ PTS Phone # (�}--- River Basin ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body C> �-' vv10-//, 4971 ❑ PWS: C_ OV Closest Maj. Wtr. Body yes )no PNA yes ' Project/ Activity 1� (Scale: ck) len h atform(s) Platform(s) :ngth tuber i0- -prap length / g distance offshore_ ax distance offshore ibic Yams mp use/ Boatlift Bulldozing ine Length r ` not sure yes xium: n/a yes I yes , no r Attached: np ding permit mayYe required by: ❑ See note on back regarding River Basin e Local Planning Jurisdiction) 73 CAMA / DREDGE & FILL I y �vUo 7-76t� PENERAL PERMIT �3 7_D 7_CC)Z� Previous p p_ • A s ermit # New —Modification Complete Reissue CPartial Reissue Date previous permit issued zed by the State of North Carolina, Department of Environmental Quality :)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached. Name _ Project Location: County Street Address/ State Road/ Lot #(s) State ZIP y E-Mail d Agent 11 CW Jt EW ` PTA OEA - HHF = IH PWS: �s / no PNA yes / no 'roject/ Activity 1 length xrn(s) _ itform(s) ,ngth- notsure yes no n/a yes no yes no — -- :hed: yes no — —_"-- iermit may be required by: al Planning jurisdiction) -1ES PTS UBA N/A Subdivision City - - ZIP Phone # (} River Basin Adj. Wtr. Body `r � Closest Maj. Wtr. Body (Scale: "�s M ONOW Neme of Perna NoMr 1rUrraer Cheek Number CMck —t Permit Number/Commentr r RNund/RNlloeale0 ' MIST ColumM Columns C.1-6 Column7 Column8 Celumn9 _ on LLC _ ty oa LLC _ n caeLLC welion, Inc Gary Sample/Jonathan Riley Simon and Adrienne Medley same Mark and Carol Tallon Debra Eichorn PA Elsie Cumbee Jim Jordan JamesMinelt Jan Peelle BUT Web Fargo SouthState Bank --_ First Citizens Bank FCB Bank of America FCB 6563 $ 400.00 iGP #76101O JO rcL 10196 1 GP 074656D _ _- PA rcL 10761 _ GP #76527D PA rcL 10764 GP #76197D BB rct. 10473 GP #76421D Bbrink rct. 10441 GP#764/7D Bbrink rct. 10443 GP#76405D Bbrinkrct.10442 - tB 'ok rct. 10421 5491 200.00 2463 $ 200.00 3155 $ 200.00 3158 200.00 6190 S 200.00 3156 200.00