56468_EVANS, SAMMY AND DENISE_20101214

1CAMA-./ ❑ DREDGE & FILL
GENERAL PERMIT �-� Previous permit#
New TModification ❑Complete Reissue 0Partial Reissue Date previous permit issue
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 � E � j J' Q Rules attached.
Applicant Name EV , p, ' may, •` ¢ s p
r
Address
City `j t i .,.a, State ZIP
Phone # Fax #
Authorized Agent --
Affected ❑ CW EW Dd PTA )] ES ElPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ElUSA ❑ N/A
❑ PWS: ❑ FC:
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P€rmitOfficer s Signa to f
Agent or plicant Printed Name
Signature ** Please read compliance statement
on back of permit'"
IssuingDate
Expiration Date
Application Fee(s)
Check #
Local Planning Jurisdiction
Rover File Name
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