58218_ULRICK, RAY AND FLORENCE_20110914

1<t?/
CAk, 4 / ] DREDGE & FILL
C ERAL PERMIT Previous permits a
New 1Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ? f • c��
[Rules attached.
Applicant Name: kc. f o{e v2�t,- _ LAIAI(, t: Project Location: County L24)( ,Svc K
Address ..31 to f ,� ✓ tf= _ Street Address/ State Road/ Lot #(s) 316 C;. ,
Stated ZlP d g 9 TV f6 x i ,1 foci
Phone # ( q?) _1_-� ,A Fax # (_.___,) Subdivision (,f G S 5 hrj 1 vI 5, w�
Authorized Agent _ City Po,C� ZIP a,}464
Affected ❑ Cw o Ew D PTA Es ❑ PTS
AEC(s): 0 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes h. fio,,' PNA yes /nog Crit.Hab. yes / ,✓
k�
Phone # River Basin Ya j,u'too k
Adj. Wtr. BodXa—v'/man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
length .. - ■■■■■■■■■�I�ww�r�■c����■■■
•!
■■■■■■■■���I■■■=
M.
M. _ =•
III -
■■■ice■
■■■■■■■■
i!
�+:
"
::
■iil��■rJ■■■■■■■■■■
■iii■■t�'■i,e�la■■l�sl■.�Naii■■■■■■B■■■■■■
■i■■■■ir■■■■�L�14j/■���Ii1■■■i■E��■i'ii',i��h©■�■�
�
■■■■■■■■■■�111�r■■■�Jrily■■lir-�■■■■■■■■■■■■■■■■■
■■■■■■■■■■■i■■■■■�li�l■■■■■■■■■■■■■■■■■■■■
��■���■■■c:csdC=�==�Jf�DL'�
■'9C�,i�G■!!��■■■■■■
• ���..�w�i■■■iii■■ii■■■■■■■■■�hJ■■■■r�G1lsl■■
■�■■■��7■■■■■■■■R■■Ill■■i■■■■■■iii■i�ii■■■
1 .-
Agent or Applicant Printed Name
R
Signature ** Please read compliance statement on back of permit'*
N /A
Application Fee(s) Check #
ice 's Sign
Q`)L1—o�D11
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name