44724_BRAY, PHIL AND SANDRA_20060328 (2)

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GE & FILL
NRAL P RMIT
Modification omplete Reissue ❑Partial Reissue
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
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Previous permit #
Date previous permit issued
❑ Rules attach
Applicant Name�°� �ll�iY%/s _ . Project Location: County j
Address_ '2 Z, _ C .PI Street Address/ State Road/ Lot #(s)
C lrGi Gu St to ,i✓� 71P 1-7 A..ee-�r.,/W,
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Phone # OL109"1041'Z' Fax # O Subdivision
Authorized Agent �iC% City �`'�? ✓ ZIP
r- C
�EW )t TA
Affected ElOEA
7—HHF ElIH
AEC(s):
❑ PWS:
❑FC:
ORW: yes /
PNA yes /6c:
Type of Project/ Activity
Notes/
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
Je
�c-- /C,- S
'Signature -** Ple6se read compliance statement on back of permit"
Iz 2
Application Fee(s) Check #
Phone # ( ) �� D/� River Basin tL'�l f-Qa ...--
Adj. Wtr. Body ((nat_irhan /unkn)
Closest Maj. Wtr. Body1�'�'
(Scale:
T�
Permit Officer's Signature
3-�(- /gyp 1---Ze 61oll
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name