33756_NC DOT_20030502

CAMA1 ❑ DREDGE & FILL`'.;; oz��
GENERAL PERMIT Previous per #
( New dModification ❑Complete Reissue ❑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 e e' 4AID�'s°„� � a 5 � '! •
A2 Rules attached.
Applicant Name
Address 1 Aig p `L ��ri2�1s� .
City ° �►tl State��.•' ZIP ai " lq5�
Phone # ( Fax #,t�
Authorized Agent 8
Affected ❑ CW
AEC(s): ''OEA
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❑ EW ❑ PTA ❑ ES ❑ PTS
Project Location: County�r
Street Address/ State Road/ Lot #(s) 13a:V6AJ
Subdivision
City 41 d ZIP';21
Phone # ( ) River Basin 669 Wore-W
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit "*
A plicationFee(s) Check#
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Pe Officer'sSignature� y� q
Issuing Pto Expiration Date
Local Planningjurisdiction Rover File Name