63469_John Suges_20181205

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'CAM REDG 3M E & FILL J Nd-,72927
GENERAL -PERM Previous per 'A - mit-
N w 'DXodificati cfiL E,Com'plete. Reissue.' 'artial Reissue Date'pre"vious per­n'ffiS'sudd � s auth 6rize:d by the" State of No'rth,,Car6Iina,-Department of Environmental Quality
,;"and the Coasfaflkesources tommissi6nin an'area of 'environmental "concern'pursuant to'I 5A NCAC
udiels att �Echred
Ap lica* t Name
p_ Project Location: County —
n
Address . Street Address/ State Road/, Lot #(s)
City S,
'tdte//// k
Phone Subdivision
Aut"Citi horiz,ecl,�ent*. zip
O!CYV EW XPTA dES PTS' Phone # River Basin
Affected -
Ls
0 OEA �OHHF 011H 0 UBA El N/A:
AEC(s): . , , - 12,1(
Adj. Wtr. Body N_ X(nat man /unkn)',
El PWS:',
Closest Maj. Win Bo
dy L; im
PRW. ye s 0 PNA yes /Eno:)
Type, of Project/ Activity
M
M.
M. M.
M.
r�■�■�■�■�'�A®mil
■■■■:■■■■■■■ll���J■':��■■�
mom
M MENEEMENEEMMMMMENNEENEEMEMEMEMM
W,
Cr
tl Agent or A p icant Printed Name:--:--'
PI —Vatern ignatyre, a b/e d ;a compliance
NO
Applicationfe
s
Per iftFeff, er_,sPtinted ame
AoK6ack of,perrInit Signature
Check# Issuing Date, Expiration Date,

NC Division of Coastalt. Habit2timpact Computer Sheet
Applicant: 0p411 Sj,�_r
Date: dIVdd 44_r, 1t2
General Permit #:
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 impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill' Both ❑ Other El
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 ❑
2-80 - 80 :. 1- -4RC T m. www.ncce st'aI �a erx� ,net revised. 02103110