20170145 Ver 1_DOC021218-02122018144158_20180212

nn,4 � c�-6R�D�E & F'LL j�j� 6� 5 5� A B c(�
� � � j���{ 1� Previous permit # "`
C�31 J�ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued "—
As authorized by the State of North Carolina, Department of Environment and Natural Resources ���, �� �� ,)� p m
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC �
� �� ules attached.
Applicant Name � Project Location: County �1� ��a ��
Address ��� r `�� `'� °1„ `� V � StreetAddress/ State Road/ Lot #(s) �� ��� �''J���" ���
c�� �f � ��'�� State�� ZIP�'���z� � ��x�, d���'��l�.,r ��I- ��-�'r� t-��
Phone # ( `�_i ci� � �{ � �-� o�s� E-May'I '1 t"1 � ��'►1 c�ov��y1 c, �'' f ��a i' Subdivision �
Authorized Agent e�n ti �'l"eP'N p ►� ' City f , � ��`� �I i�j.� � f � � ' ZIP �. �'�`'��
❑ CW L�reW LW�TA L�S �❑ PTS Phone #(_) � River Basin� V� �'�� ���
� ,. •
Affected � OEA ❑ HHF ❑ IH p UBA ❑ td/A ��b �� �,r� ���'y�
AEC(s): - _ ; Adj. Wtr. Body � na /man unkn
❑ Pws: �`+�'V� �'�/�,.�''�'i�r�n� .�r:�n
ORW: yes /�o PNA yes / no Closest Maj. Wtr. Body
Type of Project/Activity �� /�G�- I ""- ��"�"-� �t i ��..� �,.! i''�'� c� �����i��'� � ��� �v��
�� �� �� k�:.
�'i�bj.,� �vt� cy.�1`wC.l'�`�-� �N�i`.+.a^�'/�n� � }�t,���1h� f-�IO�.ai�'f�� E;,esMw�uv�bc:f�"i'19:� .�dtr� (Scale:
Pier (dock) length
Fixed Platform(s) '�
F►oating Platform(s) �
Finger pier(s)
Groin length ''
number "
Bulkhead/ Riprap length —
avg distance offshore '�
max distance offshore `
Basin, channel "
cubicyards '—
Boat ramp �
Boathouse/ Boatlift �
Beach Bulidozing '
Other �� � � �% -� t`T c�
~] �� r B��, �,�� i t��
�,5�-i' �� W�q�' �f�ny
Shoreline Length �
SAV: not sure
Moratorium: n/a
Photos:
Waiver Attached:
yes �
ye' no
e no
yes �
a
� f��
)
A buiiding permit may be required by: ��f �� � �a��� ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdictio � � t� � �. �;' � �, �-� f' ��� p �� � ��..
Notes/SpecialConditions � �'° 3r���''�`� � �''��� '�r R�O�� �°� � � '� �y � 1
L,jj�,���i' e�lor o���•��u� �'r�;� ��-iM. ���e.. .�.;r�l�`�� brJ��y.�..r�.��� �a.� e^.e.wi�.✓.� J� 1.r n...��t�-�%i('�'��c �l���
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j"et �+s.�.1�u,NJ k'f"f I o'►'`�l �'P n.R.!
Agent or Applicant Printed Name �
Signature �� Please read compliance statement on back of permit ��'
.�!( t�� �"' � � 1 7 � P �° � s '�f �
AoolicationFeels) s� Check#
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PermitOffi er'�am�
Signatu�/� j � � �
'' j � !�
Issuing Date ' Expiration Date