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' ACAMA / -/DREDGE & FILL
GENERAL PERMIT Previous Permit # `^ B c °
-`New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina. Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC i j Ob
pQ - Rules attached.
Applicant Name ia,� '1' T� r : i�Cr. c 1-- Project Location: County,.', {k-
Address 336 Lc,!� Ot : vP, street Address/ State Road/ Lot #(s) Iat, J I i + 1 ag,
city Its&,r'ca _ _. _ State fA ZIP_ 1S2LK I 1,1e+ L o-9 , La -I' Y3,Y2, - q1
Phone # ( ) E-Mail LwL.J-_t Ord 1 @tt+rw�.Ae i-- Subdivision Ts Lc-d sl't;fes r�cf;
Authorized Agent ij.r„ SV,: {I.` City (rr.^Jy ZIP 7� .P
Affected Cw ✓ W /PTA .TES PTS Phone # ( ) River Basin
OEA NHF IN USA ' N/A --�__
_:
AEC(s): Adj. Wtr. BodyC .c I _ tz, f�J l y� _ -Lnat man - nkn)
PWS: j' - t
ORW: yes � PNA yes 1 tw Closest Maj. Wtr. Body CWf I f4 1_6t..sd
Type of Pro*V Activity @ Inlay ,o �,..�n-S' lit it k eg j
(Scale: I'�
Pier (dock) length
Fined Platform(s)
Floating KVfon(5)
Finger ems)
Groin length - -- -
number
I iPry length -CIO'
avg distance offshore oo't
max distance offshore 2 _
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boadift }
Beach Bulldozing
Other
pIL
Shoreline Length
SAM not sure yes
Moratorium: Cn7P yes no
Photos: CY no plop
Waiver Attached: yes ^
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
l.Gt it se'; +K 1-1
Agent or Applicant Printed Name
Signature " Please read compliance statement on back of permit'"
4 , .a0 of95 ?ef GP# 9,80
Application Fee(s) Check #
91L .
See note on back regarding River Basin rules.
errrntOfficer's Printed Name ,J
Signature
-31-
Issuing Date
4Z Sec. q. 3 $
AGA
.=:= _Mmwm�
NCDD4R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
EL-rerty Eaves Perdue, Governor .lames N. Gregson, Director Dee Freeman. Se[aetary
Date .a' b'3 1 wit
Name of Property Owner Applying for Permit:
r -)- rns
4
_YIailing Address:
3 `'�S? L.cn er
PA
I certify that I have authorized (agent) _()qC rn '-SC t 4:) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) ( , I : 1 tlCC__
This certification is valid thru (date)
Property Owner Signature
phe- C -at,
6.sk'r'"r k-
Date
400 Commerce Avenue, Morehead City, North Carolina 28567
Phone: 252-808-2808 E FAX: 252-247-33301 Internet: www.nccoastalmanagement.net
An Equal Opportunity', Affirmative AcWn Employer — 50% Recycled t 10% Post Consumer Paper
DMSION OF COASTAL MANAGEMENT
1 hereby certify that I own property adjacent to �`l S `s
}} �+� (N�Name of Property Owner)
property I0cat6d at ► , f n � 4" i_ Av _
} (P ject Site: Address, Lot, Bloc* Road, etc.)
oin 0 LCLA N.G.
(Waterbody) (C own and/or County) Agent's Name #:� )-Snu Mailing Address: P 6 eb! �4-1
Agent's phone
Fie/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Indholdual proposing developmerrf must fill In Oescripfion bel w or attach a site drawing)
ff you have objections to whatls beftpropow4 you must nofi do DFvislnn of CbasW Mbnag mnent
(DCU) In writing wfihin 10 days of receipt of this notice. Correwondwme should be mailed to 401 S.
GrWn' M . StG 3W. EFaMbeth Cibo NC 27WQ WU r+•pnwwdsdvuw can also be conft~st(2M 264-
} Sfgnefure
Print or Type Name
_2 Lt, DAAte ffinq Address
>r
f PA 6 �
1 TelePhone Number/ Emed Address
Daft
"Vald for one calendar year after sionawre'
Making Address
L t-Sc' i
Cifylstefuu!
Telephone Number / Erna# Address
Date*
Reh+ie3d Ann "7
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you. - ; 4
■ Attach this card to the back of the mailpiece
or on the front if space permits, ' - F
. Article Addressed to:
a�c� Lud(�e
/3c4 6rt it-,,,f�u�f�'tp.
f}c-C_C;�zrzk�Yvlp C>4,a' C77
111111111111111111111
9590 9402 4821 9032 5388 gg
0160 0000 98
3577
PS Form 3811, July 2015 PSN 7530-02-000-9053
B. Received by (Printed Name)
D. Is delivery address different from item 1 ?
If YES, enter delivery address below:
3. Service Type
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Certified Mail®
El Certified Mail Restricted Delivery
❑ Collect on Delivery
^ollect on Delivery Restricted Delivery
3sured Mail
Isured Mail Restricted Delivery
(over $5oo)
C3 Agent
❑ Addressee
)atee of Delivery l
❑ No
❑ Priority Mail Express@
0 Registered MailTm
❑ Registered Mail Restricted
Delivery
❑ Return Receipt for
Merchandise
❑ Signature ConfirmationTM
❑ Signature Confirmation
Restricted Delivery
Domestic Return Receipt
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