63301_Ronald Coburn_20181024

fi AMA /I DREDGE &' FILL NO: 72921. • -'
to33ol A B C D
• GENERAL.." PERMIT Previouspermit# �
New ' I]Modiflcation; ❑complete Reissue El Partial Reissue Date previous "permit issued _ /L%//�' "
As authorized by the State of;North'Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC, ' d
Rules attached.
dAApplicant Name
Address p O.' i3oaC C1��.
City lid7"y/ State_/ ZIP�� G
Phone # () E-Mail r
Authorized Agent. T oB-1..Z i12TPA 9,1 S5 S7
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS:
ORW: yes / no
PNA yes / no
Project Location: County Pr zTrogi-
Street Address/ State Road/ Lot #(s)
04
-Subdivision F-1 V rW_tJAR I'
"City W IAV) zip 71$L
Phone # ( ) River Basin /� f10 L/A
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Signature Pfease'read compliance statement on back of permit
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Application Fee(s) Check #
Permit Officer'5, Printed Naa
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Signature
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Issuing Date — Expiration Date

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Applicant: �o I 0� C A U � ►'�
Date: � q & of" Zo I 1�>
General Permit* 7 2 V Z(- 5
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
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp im pads
FINAL Feet ,
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
WAfTYZDredge
❑ Fill ❑ Both ❑ Other�—
6
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑