39975_ETHERIDGE, KAREN; ELMER ROPER_20050204

:gAMA / E DREDGE & FILL
GENERAL PERMIT
ZNew ❑Modification ❑Complete Reissue ---❑Partial Rei
As authorized by the State of North Carolina, Department ofrnta�l
nment and
and the Coastal Resources Commission in an area of environconcernpu
J,
Applicant Name �. /�;r;t� ✓`'�4:
Address .{L r h = �' Y 4-
City l +x' %� i c , �`' Stater ZIP _ `7,s
�. r
Phone # ��) r �- � ��� Fax #
Authorized Agent ---
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Affected AO
AEC(s): EA ❑ HHF ElIH ❑ UBA ElN/A
❑ PWS: ❑ FC:
9
Previous permit #
�\ Date previous permit issued
at al Resources
uan to I SA NCAC
N Rules attached.
roject Location: County 7)
Street Address/ State Road/ Lot #(s)
6 - = r / 7
Subdivision
City k ZIP
Phone # ,.5 G'O Z U.? River Basin
Adj. Wtr. Body 171 4 / 14 c l '�n t an /unkn)
��
■■■
sir
length
■■
number
avg distance offshore
max distance offshore-
■■■■■
■■
■
--
�i�
,.■
ii
' ..
■
■■■■■t�i
®:1■
'
cubic yards
■�
ramp
Bulldozing
■■■■■■.�!
'�MEtl
16wop
■■■■■■■■dine
WO
Length
■■S■■■®
ME
.'i�il■q■■
not sure yes
wags: not sure yes
no
I
ME
ME
■■p■■�
■
f
■■(/�■■■FIS:
■■■�
_
Agent� A-11-1,�6 AA L^,, ) -
or Applicant Printed Name
Signature "Please read complianc4 statement on back of permit"
Application Fee(s) Check #