GP68667A_General Permit_20180307

Previous permit #
[Aew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by State of North Carolina; Department of Environment and Natural Resources G��
and the Coastal Resources. Commission in an area of environmental concern pursuant to 15A NCAC =>00 Leyoo
❑ Rules attached.
Applicant Name NC. POT Project Location: County (} %}� D w j(000
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Address 1- ,A I C'floP"i' FIF , �.v t'T E 10 Street Address/ State Road/ Lot #(s) V-ATtV I I e. J
City i Jc.sue.;(6'� State N% ZIP (� jc1 `,fryox' / •(D mtt.t� V Ida
one ( ,) a
E-Mail f c - I h., ( _ Q hcc c, t_ cl.v
Authorized Agent
P\VL.
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5
❑CW R(EW
❑PTA
El ES
❑PTS
Affected
AEC(s): Ll.OFA ❑ HHF
❑ IH
❑ UBA
❑ N/A
❑ PWS:
Agent or Applicant Rrinted NamQ,`',{[:/}11 �
Signature "� w Pleas mpliance statementsp on back of permit"
Application Fee(s)
Check#
City Gc*tt• 1cc. ( ZIP
Phone# () ^" River Basin f'1t� •oT/ONk
Adj. Wtr. Body (riaij) man /unkn)
M,; XAe«,. n,.a., /"�.i '717ufb.' f;ucsc•..5�
PermitOffcer's Printed Name
Signature
C�61 �rr 6 Jy
Expira'fion Date