63699_Matthew Nease_20190123

C^! / ❑,DREDGE. & FILL
GENERAL PERMIT Previous permit-#s�
C`New ❑Modification . ❑Complete Reissue, `-'❑Partial Reissue Date previous permit issued
As authorized byahe State of North Carolina; Department of Environmental Quality :
and the -Coastal Resources Commission in an•area of environmental concern pursuant to 15A NCAC
C/�ftulettached:.•;
Applicant Name All, Z4,: G Project Location: County, ��/U'j[���f r � .•
' Address `�O� '�/`�ii� (" l%7�1 �����') Street Address/ State Road /"Lot #(s) /
City f 2 4l�/!Ui (�� - State /yGZIP
"Phone # (ova)' ?I l�Sr�'1E'Mail Subdivision V
44
'Authorized Agent r r c� City ;ZIP • v2
❑ CW 1; WJ�TA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected
AEC(s): 11 El I oEA HHF H ElUBA ❑ N/A
❑ PWS:
ORW: yes / PNA yes / xo
Acil. Wtr. Body
`-Closest Maj. Wtr. Body
11
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Agen or Appli a P •inted rqam
Sig ** Please read compliance sta ement on back of permit
Application Fee(s) Check#
er i Officer' Pr'ntefJ Name
Signature
Issuing Date E piration Date

C Division
. of Coastal Mgt. Habitat impact Compute- Sheet
Applicant:
Date: p
General Permit #: 7�;A
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
.total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
.temp impact
temp impacts)
impact amount)
- temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other,
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Dredge ❑ Fill ❑ Both ❑ Other/6a
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Dredge ❑ Fill ❑ Both ❑ Other ❑
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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 ❑
�52-€ 08-2808 :. 1- B-41RCOAS f ;c +vvv,v,r c i s c asx rak. r ; t evised.