71546A_General Permit_20181016

AMA / DREDGEdi4 FILL N2 71546
CA) B C D
N La_�ERMIT Previous permit#
ew odificatio9 �be Reissue ❑Partial Reissue Date previous permit issued
As authorized b the State o No h/Car lina� a rtment of Environmental Quality �s
and the Coastal Re ces Commission inana ea of environmental concern pursuant to ISA NCAC / // , / L- b '�'
/ ales attached.
Applicant Name omaf 7 /� 'I'I'i c• t. 460Adit Project Location: County X1 wf �
Address PO
6 X 3 o 3 7
City {�. // ®e
✓' / , //S State / J C ZIP 2 7 c/ ^
Phone #(1$) 2 o2'�t/3i E-Mail cu��e r°liob�p yNo./,
Authonized.Agent-
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�,EW VRTA ❑ES ❑PTS
Affected
AEC(s): 00EA
❑HHF ❑IH ❑UBA DN/A
❑ PWS:
ORW: yes / 6io'�>
PNA yas / no
Street Address/ State Road/ Lot #(s) / o + T
O �cl,r r-s/r,d ➢r,
Cl ty N N d zIP zus9�,
Phone# River Basin
Adj. Wtr. Body C a d rx / (nat a�/unknl
Closest Maj. Wtr. Body R o a n okc.
Type of Project/ Activity CQ t 'f r �'' /t o p' r / P / t �a (�M / 4- 9, k+ k (7+
(Scale: �: ZQ )
Pier
fixer
Fingc
Gro
Bulk]
Beer
Boat
Boat
Beac
OtN
Sher
SAV
Mo
Phot
Wai
i
A building permit may be required by:
( Note Local Planning Jurisdiction) ^
Notes/ Special Conditions �� Ma-'!e �y /5� �-(- 914?y
Ag n [Applicant rime Jame
ignature 's Please read compliance stIPment on back ofpermit Me
9/2 oD " 9 35'/
Application Fee(s) Check#
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❑ See note on back regarding River Basin rules.
rgnc CAC-J^�
PermltOffcer's Printed Name
Sign;jure
Issuing Date Expiration Date