63728_Kristie Montague_20190212

J -E] 0 ❑kEbGiI2:Ji 1
'?r L
revi6u§,.p6rrnit
GEN
;17t 1�
0�kq.-p'reviousperrnit.issU-
El bC'oi:h'p'Iete Reissue, S
bw ❑Modificati , on" EIF artia eiss diei&
i3,.Ht_i2VR6i lu_�e
Y
pAs authorized by:tlfe Stite of North Caeoliha, DppaCtrnent of -Environmental Quality,
Coastal ission in an area of environmental and the tal keiso'brc�e'§_,,C`ornm_ I concern pursuant to- I 5A;N�ZAC.`
z
~'Applicant Location: --County, t Narn�� . V-11 -�V Project n: --Co.tjqty,,
V, `.116adftot' /-7,
Address .4--iS� Q 4�1 Street Addres's/,State #(s
'Al
City
State H" (--ZIP-' L A9
Phone Subdivision
AbtHorized Agent City 2-Ir
L;>
Cw pqv�, rTA [3kS 'El PTS Phone # J�imer Basin
Affected . li - L) t-�-,
. E-1,0EA 0 HHF IH El UBA -0 N/A (na /man /LinUn
-AEC(s): 'Adj. Wtr.'Body
El PWS:
ORW: -yes/ PNA yes no Closest Maj. Wtr. Body
Type of Project/ Activity �Pl f-7>1
(Scale:
Fixed
i
F i
Tinge
z: Groi
d.
Basin
Boat
'Boat
Beac
Oth(
Shor
SAV
Mor
Phoi
Wain
MIN
W
111R
MIMI
MEMIMMEMEMMEMEN
MEMMEMEMMOMEMEMME
MEMMOMMEMOMMOMME0
MINNIPA-1001
0-
Comm
P
JEMENEM
MEN
ONEREMEME
NOME
i Bulldo�_
MM111M1M1M
IIMMMMMMMMIMM■
MMMMWMIJMMM
ONMEM
MONIONMEM
EMEMM
VNIFINN■jrq.,q.MMMMMMM■IMEMEMMEN
Length 4
(::�not A�sur yes no
i &or
"IREMMOMMI'm
Mffdft!wR!M
ROMEWOROMMIMEMEM
MOMME
201MINEMMEME
gonz-Mmiga■WOMMEMEN
ME
Z-04NNUMMEM
n/a 'yes
WS: yes
Pr V q
lee note on back regarding River Basin rules.
'A building permit may be required by:
(.Note Local Planning jurisdiction)
Notes/ Special Conditions L,OFT -z,
-2- i2l
7
A/
Agent orA ppli t,P Me
Signature g6pliance statement on back of permit
Application Fee(s) Check #
Sigpa'ture
4)1
Issuing Date -Eipiration Date
M
w

Applicant:I�
Date: 12TLu «2� Z� 1
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
ternkn acts)
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
© t7S
Dredge ❑ Fill ❑ Both ❑ Others
Dredge ❑ Fll ❑ 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 ❑