63300_David Chambler_20181024

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N ERAL`-,.,,PERM1T Previous.permit #
ew-,. Emodification".- ❑C onoletekeiss6e EPartW Reissue Date 'Previous -p' rm7itis§AcState As authorized by the St N9r,tkCarolina,Department of Environmental Quality
, of
and the Coastal Resources,Cornmission in an area oflenvironmental cohcern.pursu'ant to 15ANCAC Q?1kJ'ZO()'
E Rules attached.,
ApplicantName DAVILCOAAW.61-L Project Lo6tion: Couhty, /-/ F)Z-rFQ1ZQ
AddressStreet Addrd'ss/- State Road/ Lot #(s)-I() 8. Li. Pr_`
— ME
City. State AK ZIP
Phone
E-Mail
Authoriied'Agent
'I VT
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:Affected
MTA El ES,
.0 FTS.
-
AEC(s): - 0 OEA
El HHF El I-H 0 UBA
,
El NIA
El PWS:
: -,
' 1-17N
ORW: yes ( o
PINIA yes 100
N 0 R k' S, -
SubdivisionAk r.-
City' WwTptj ZIP-27fzL-
Phone # tg"/ 0. River Basin C}10 LJAIJ
Adj. Wtr. 136dy_iz, vr x nnat� man - /unkn
Closest Maj. Wtr. Body C, 140-WAJ (& YL
Mill!►
MENNEN
W1110,011 E
MEN 111111MEAMMINKINIM
MEN
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M.
M. M.
MEN
MEMMEMENNE
mom,
Agent
read compliance statement on back of permit"
_q 701).166, IbG771
-Application Fee(s), Check #
VF-Vild 1,)Atz,//
Permit Officer's Printed Name
Signature
Issuing Date - 'Expiration Date

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Applicant: bath J to anll b )ems
Date: pc -
General Permit M 7 Z g Z Z
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet. '
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft
(Anticipated final
disturbance.
Excludes any'L
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)-
F �
Dredge ❑ Fill —Both ❑ Other
.
60 (-T y
_
3 oD F, Z
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge-0 Fill ❑ Both . ❑ Other 0--
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
a