43055_SMITH, VIRGIL_20060307 (2)

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/ O DREDGE &FILLN? 43055/
RAL PERMIT Previous Permit#
ewModification ❑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�-- pa--�. �ri s w-
Rules attached. L "" `� " '
Applicant Name``
Address Ivy
City State-lt, ZIP
Phone # Fax # ()
Authorized Agent�'�
❑ CW EW -�-PTA VLES ❑ PTS
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS: ❑ FC:
/6)
Project Location: County NVL
Street Address/ State Road/ Lot #(s) N C
Subdivision
City ZIP
Phone # ('-%y River Basin}u
Adj. Wtr. Body 'TO r a /man /unkn)
Closest Maj. Wtr, Body f a>�Ile Wele 2"�
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number
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prap length
avg distance offshore
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max distance offshore
channel
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cubic yards
ramp
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Ildozing
Ane Length
not sure yes
gags: not sure yes
torium: (nfd yes no
Ds: a n0
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Agent licant/ Printed Name
Sign re ** Please read compliance statement on back of permit
Application Fee(s) Check #
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Local Plan nnn gJurisdiction Rover File Name