GP68739A_General Permit_20180312

ltl`CAMA / ❑ DREDGE & PILL
GENERAL PERMIT
B
Previous permit#
C D
'Z[New ❑Modification ❑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 15ANCAC f":)
11 Rules attached.
Applicant Name
Project Location: County i,i,'1/1i41e
Address I % P I �< < I ( -` j It .<.I
Street Address/State Road/ Lot #(s)
City � I�G i, I��C AK1r State V 7 ZIP
[:,'+t� "=i hrl/NI( i)ilivr,.: `
Phone # (/ rf)^'a, , ] `5722 1 E-Mail
Subdivision 0.�t.1"V I'L C::UtiJ (.! 4I I ri
Authorized Agent
City �.1. r8 !` i 7 � ZIP r I I
❑ CW 7EW .kPTA JES ❑ PTS
Phone # (i) l) i `tt j c ; [,,;=; River Basin j !l t t'(..li
Affected O OEA HHF ❑ IH ❑ UBA ❑ N/A
❑
AEC(s):
Adj. Wtr. Body (V
rrC.I -
6U_"i [L l;tJ I dr(Sf /man /unkn)
❑ PWS:
Closest Maj. Wtr. Body (Ff.°- r
ORW: yes / fno j PNA yes / (t"o)
Agent or Applicant Printed Name `
Signature jj ** Please read compliance statement on backofpermit"
Applicatio Fee(s) Check#
Permit Oficer's((Panted rName
Signature
L(f✓°/°['/ ! Eta S[(L�.+' y !r« Frl'.`.e
Issuing Date / Expiration Date