40055_COWDEN, ROBERT_20041008 (2)

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N° 4QQ55
Q 6AMA / Fn�OREDGE 84 FILL
GENERAL - PERMIT Previous Permit #
[��ew ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued N
As authorized by the State of North Carolina, Department of Environment and Natural Resources U J s Q 0
and the Coastal Resources Commission in an area of envir�.me concern pursuant to 15A NCAC I f u es attached.
Applicant Name Project Location: County
rid �( Q. Street Address/ State Road/ Lot #(s) f� 1
Address � � Q if 1,.w�,.
O f ^f"� State ZIP
City -70 N
Phone # (� � Fax # (—) � Subdivision
._.._ city
j11eri11t ,P/ C ZIP a �s
Authorized Agent
CW ��l N+JA C ES [IPTS Ri B in
Affected c oEA El HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): ❑ FC:
❑ PWS:
Phone # (_) I— ver as
Adj. Wtr. Body at man unkn
Closest Maj. Wtr. Body

ALLSTAR SEAMLESS GUTTERS
PO BOX 1054
ORIENTAL, NC 28571
WAICHOVIA,
Wachovia Bank, N.A.
H �VT 053000 1
POrt
1:0 S 3000 2 191: 20078400
_ 1302
aRM1CH 90315
DATE
DOLLARS
B.c4.
PH:25-249-3781
138 Soil'
1302