52968_FIKE, DAVID & KERI_20090114

�7CAMA/ NIDREDGE & FILL
GENERAL PERMIT Previous permit #
G New ' Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issue Cps,,
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 OCT
EgRules attach . 01%
Applicantt,Name ay, Project Location: County C;,, bf6
Address a+'01 Vtne 0 N1 ,, , '� - l l- to 6 Street Address/ State Road/ Lot #(s)
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City },~ �`� `� e S�F``, � co �x 3fv,,, , �- ; 5�..� r, c 1 L a
—mac � y: �tyc.c. vldo3�Z ha. aL$�cs)
Phone # (;) Fax '# (=) bY• t AvII,.�Jr}..i..,. Subdivision �v Y , , c �( C j y�
Authorized Agent k,�V�.+
Affected ElCW EW ® PTA [��ES ElPTS
AEC(s): ❑ OEA ❑ HHF '❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /,no
❑ FC:
PNA yes /`no Crit.Hab. yes /,ono
City CO, 00c. ZIP c�
Phone # (_) River Basin Jac sl Lo :)c,, ,
Adj. Wtr. Body C v r + •' ,.) cc i! `:_ v nat.•/man /unkn)
Closest Maj. Wtr. Body S 6, r "
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ONE
Agent or Applicant Printed N e
UM
Signature * Please read compliange statement on back of permit
Application Fee(s) Check A.
`—'PermitOfficer'sSignail7 e y
R.R.Q.
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name