32931_KEHL, FRANK_20021121

AMA / S-OREDGE & FILL AGENERAL PERMIT. ..:;.
Previous permit # -
SKew ElModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources 1I
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC00 1 a CO
L�Rates attached. Tr
Applicant Name �Y_ :,� �1 Project Location: County
Address ICI` � %QO'f)c�r Street Address/ State Road/ Lot #(s)
City 1V C��, i P r Stated ZI P S ,</,,O
Phone # ( ) (2q 1 Fax # () Subdivision �f� �r
Authorized Agent City ZIP
Affected ❑ CW Q-PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC S : ❑ OEA ❑ HHF ElIH ❑ UBA ❑ N/A
() Adj. Wtr. Body 1� 1D �t> pR Cy'� L (nat / ian /unkn)
❑ PWS: ❑FC:
ORW: yes no PNA yes no Crit. Hab. yes / no Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit
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Application Fee(sl Check#
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Issuing Date Expiration Date
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Local Plan ningjunsdiction Rover File Name