63478_Ellis E Phillips III_20181214

N
AmA DRIED E•-
G &FILLo,,72941iO , %B C
'GENERAL L•PEERMIT'Previous perm!t-# 1
r A-�
mp, Aeissue".' Reiss)ue
NeW EJModificati�n­ 'E]'Cb l6te Date previous pprnni, issued
H !d, by. the State'-6f'N6rth Car 1i6a, Department of Env'ir6nmental Quality aut or1ZE y
aq'd�ihe"Coaital'Re i er Coastal -Resources Commission in an area of envir'onmental,&nc n,oursuant'to I SA-NCAC
EiyRUlbs att
ached:'.
,'Aoplitaint'Na me 6-:: Project LOcation coun Address' /'Z 3 Street, Addressi,StateRoad/'Loii, #(s),
-Ci State 1-/�'C. P
Phone # -E-Mail
Subdivision' t4
Authorized Agent - City i, :ZIP
Affe&ed' ❑ �EW,, �PTA EES EPTS Phone # River Basi
2
0 OEA El HHF' 0 1H EYUBA 0 N/A
AEC(s): Adj. Wtr.'Bod 2- 1z 6 Lna man, /u6kn)
El PWS:
Closest Maj. Wtr.'Body- 3' P:��7
ORW: , -yes (a�) PNA ye� 3/n
1%15
IMEMMEMMENEMEM MENEM
MINES EMN
MEMEMMEMEMEMEMMIMME
-.. ... - :
■�IN■■IN■
MIN■
Cil■IN■■�■MIN■EIN■INM
■ININ■MINM■■
MENIMME
NIMME..�...■�.....�::�.�:�■...■...■.
ommomm-m-ri'm
MON
immiummomodomom■mum
M. M.
MEMEMEMEMEMEMEM
■
EMIMMEM1111MMEM ME■■■EME■E■�C■■■E■IC■MMEN MEMN MEMMENN
EM
■A■■■■■■■
MENMEW11111111116"IS"
MMIMMNMEMMIMMUnI��EE■■
MIMEMOMMMEMOMMO
NINE= Mw1MMMwMMM1
■■■O"I"ROMME
IMMIMMENIMMEMOMMEMIMM
---
0 MIMMMMMMIMMMEMM
IMEMEMEMEMENIMEME
MEN
MOSLEM
-MEM
--AI
MEMMUMEMEMMEMMENNOW
—
M. -1 r
x
Printed Name Age t o Applicant Printed Name
Slgqaure­" Please read compliance statement on back of permit
Application Fed(t), Check #
_RermifOff—jcyr's;P)rfted Name
J I
Issuing Date Expiration Date %

a
*9�� �-PWYY,
Ml XV-6
69
Ell N 11 6 Wag
ru
w OW bm `!tare m
Rl OW
,olt"W"'Rx" Ilm-w- wwo-14
AMP" k, j I am
2

Applicant E?-4 r 5
Date: —72 q 1
•General Permit # /G�M �]L
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 Flame
J
DISTURB TYPE
Choose One
TOTAL Sy. FL
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft
(Anticipated final
disturbance.
Excludes any
restoration
and/ortemp
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
b�JEI�(
Dredge ❑ Fill ❑ Both ❑ Other J�-
�i o 3 (� jr:�.
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other [I -
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 ❑