54310_RICE, TOM_20090729 (2)

LAMA /DREDGE & FILL e Q
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ENERAL PERMIT Previous permit#
ew ❑Modification []Complete Reissue ❑P issue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and"Natural Resoprces �j / ( j
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / P t f '10 -70 + ,
ules attache0_
Applicant Name i 1�i�___t r <.,.:. Project Location: County -
Address e. I�ylie,
Street Address/ State Road/ Lot #(s)
City : vrwy " State ZIP'
Phone ( ) ax # ( Subdivision
s
Authorized.Agent
Affected ❑ CW j TA ` PTS
AEC(s): ❑ OEA ❑ HHF �O IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes PNA yes Crit.Hab. yes / IKIi `�
City ZIP
Phone # () Ri er Basin W
Adj. Wtr. Body Ot nat man kn
Closest Maj. Wtr. Body 4
e of Project/ Activity I
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Aicant Printed Name Permit ficer's Si ature
Please read compliance statement on back Issu' Da Expiry n Date
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ee(s) Check # Local Plannmg)urisdiction Rover File Name