58774_SPENCER, KIMBERLY_20120509

❑,CAMA / ❑DREDGE & FILL RrC��-�,,, �✓ ` � � f� , . , pT
GENE. PERMIT �' `~ Previous permit#
❑New odification s ❑Complete Reissue [-]Partial Reissue �� ®% Date previous permit issued
As authorized by th`tate4or<; h Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCACO®
ules attached
Applicant Name
C ..)
Address'
City a
State ZIP_
Phone # ( Fax # ( )
Authorized Agent
TIM GMTA 9V
Affected ElCW
E�EW {I.PTA ❑ ES ElPTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs:
❑ FC:
r-
ORW: yes nd
PNA yes /i Crit.Hab. yes /i no
i. F'
Project Location: County(1Cf�
Street Address/ State Road/ Lot #(s)
Subdivision
City YERTEU 1�.p zIP0 9
Phone # ( ) River Basin
Adj. Wtr. Body `1� t111ih`W!S AValnea7t )/man /unkn)
Closest Maj. Wtr. Body ✓/4?
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Agent or A.I plOinte
Signature * P*�" ead compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer' Signature
Issuing Dake Expi ti n
U I n4 Aw� C-05`
Local Planning Jurisdictio Rover File Name