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