3968_BRADLEY, MICHAEL_20040826 (2)

YC'AMA / DREDGE & FILL _ v
GENERAL F'MIT Previous permit # � la
❑New ❑Modification gComplete Reissue ❑Partial Reissue Date previous permit issued30 D
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area Jof environmental concern pursuant to I SA NCAC ❑ Rules attached.
( { LLd 1 �' Project Location: County ��9 eTE/L9-T
Applicant Name_�a,�, l y— --
Address---/D
Cm, IpeaU,9,-,T _ _ State AI& ZIP -,2g5/4 _
Phone # (1� ji�j��l "log Fax # (_)
Authorized Agent
Affected ❑ CW Cw
AEC(s): El OEA
❑ Fws:,
ORW: yes / 00
r?CW L7'PfrA ❑ ES ❑ FTS
❑ HHF ❑ IH ❑ UBA ❑ WA
❑ FC_ _
PNA yes / bd
Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City
Ar✓I e
ZIP
Phone # () River Basin
Adj. Wtr. Body�R `� u�� ( nat /man /unkn)
Closest Maj. Win Body r ! PP wd
Type of Project/ Actnnty � �� � - '� T /A9e
T
Pier (d«k) ► __ 7`�'.,. y.,..
Platforms) �� a ,
Notes/ Special Conditions /V
/57 exc4
be-r
Agent or Applicant Printed Name
Signature ** Please read comph statement on back of permit F*
1 A n o0 tlf7/1 /
Permit Officer's Signature
Issuing Date Expiration Date