38786_WARNER, ANN_20050202

XCAMA /A DREDGE do FILL .per
GENERAL PERMIT Previous permit # erlx
XNew ❑Modification El 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 I SA NCAC
\,p'Rules attached.
Applicant Name_Az2 &)4r&e- i Project Location: County
Street Address/ State Road/ Lot #(s)
Address °� �' ��?,,`� - ���
City �iGsrd-�L_f_�1 StateZ. ZIP
Phone ## —° Fax # (_)
Authorized Agen
❑ CW kEW ZPTA ZES ❑ P T S
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A _~
AEC(s):
❑ PWS: ❑ FC:
ORW: yes /i PNA yes /� o Crit. Hab. yes / no
Subdivisionr<i
City oc-me, ZIP
Phone # �f River Basin : �,r 1_
Adj. Wtr. Body s'� r' ��eF� (°.�^✓ lnat L
Closest Maj. Wtr. Body
Si atur ' ` Please read compliance statement on back of permit ** IssuingDat.a Expiration DaO
�'� P P� 'f