63838_Jim Wulforst_20190305

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72-991 C., D
GENERA PERMIT
Previous perm
ew'-- EIMO,dificaii6n",,EICO'i'hplete,,Reissup ElPartial, Reissue: Date previous ,permilitissueid
As autkorized,by the Staib,of-North Carolina, Departrn6nt,6f EnvironmentaI'Quality '
-
and th6'Coastal Resiources'Cornrfiission in'an area of environmental concern,pursuant to'I5A'NCAC
:
Applica6t-Name,S
-XW69 attached.
Project Locaii6n: County.,4,,IPW
Addriess-
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Stre'et;Ad&pssfta ad[Lot # (s)
-City State ZIP'
Phone -Mail
Subdivision
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Phone.#,�- River Basin 9N
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Affected -1 OEA El HHF. El 1H 0 UBA 0 N/A
AEC(s):
'Adj. Wtr. Body at I an unkn)
0 PWS:
ORW: yes //P PNA yes no no
Closest Maj. Wtr. Body
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Type of Proije t/ Activity llrl0l"Fr
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Signatul4e J* Please read c'o;nplia'nce' Statement on back of permit
Application Fee(s) Check #

Applicant.�
Date:
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.
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 ❑ OtherA
( A
--�
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 ❑
262- 08- 808 -- 1- ,8-4Of furies - ;03M0