30027_MERRELL, DAN_20020925 (2)

C CAMA / ❑DREDGE & FILL - /{/ 9 MN i -
GEi'iIERAL PERMIT Previous permit#
New 1 cation ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 Z 1 / • !� rp
Rules attached.
Applicant Name L)11 f� Cr t EGG
Address —/",I Ue
l.. /7 Ga State ZI P
Phone # Fax # (_)
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Authorized Agent /�C/ ri �,i� -- 1>LAA4,1A)
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AEC(s):
Affected ElOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Project Location: County D 4w
Street Address/ State Road/ Lot #(s)
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Subdivision V, c6 Ll h, I0
city ifttd �r /I L /tt (� S: ZIP 2761
Phone # _ � � River Basin At5CUo1A�_
Adj. Wtr. Body�� AMA4 k -Kr`)3' An —at) /man /unkn)
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Agent or Printed Name
Signature'*Please read compliance statement onback ofpermit
4licatlonFee(s) : Check#