63418_Billie Mitchell harrison_20181206

IVIATI;�. FILL
cliN bREDGE& No., 72928"
M I
GENERAL. ou rmit --PER Previous pe ''
El Modification E]Ctomol6te�Reiss'ud ''D Partial Reissue Date previous per
XNeW- Mcidific n rnii issued
_As�authorized .by ihe'State ofNorth Carolina,, Dep4 ft' Quality
m-
ent:of Environmental
�'and.the._C6s`tal, Resources Commissio'n Inan area -of environmental concern pursuant to 15A NCAC /7.
;®Rules -attached. Applicant Name' _oll-) Projectlocatiori: C,ounty '42; Address16� Street Address/ State Road/ L City - &4/ &/,�- -ifl -
State ZIP' , oZ>V
Phone
-Mail
Authorized Agent
El Cw )EW �PTA JkES /[tPTS
Affected. , AEC(s): 0 OEA El HHF 0 11H' F-i uBA o N/A
0 PWS:
-'ORW: yes yes
if P0 PNA rlo�
SubdiVision'
City- ZIP.
Phone # River Basin
Adj. Wtr. Bodydnat,/m'an/unkn-
4�_�r
Closest Maj. Wtr. Body—
MEMOMMUNJUMMOMMES
SBMMMMMMMMMMMMMMMNMM
IM
M.
MQUEEMOMIMEM
MMMEMOMM
ME M.
EXAMEMEN
MEMMOMMEMEMEMEMMMMUMA EMEMMEEMEMMMEN
CCMC■■■■■■■■■■■■■■■■■■■■■�
`-����-•.-�■■■■■■■■■■
P rmitOfficer, Printed Name
Ag64 orApplicant Printed Name
sig"PI "ere; d Hance statement on back of permit Signature_natur I a comp
62 X
E��iration Daie
Ap��Iication Fee(s) Check # issuing Date

=Jw ww6mw mh
-hoc#
12901 AM-
etw -A

000
NO 0 �lmm
-mum,
SNOW
~_rdi in
Ox MIA
pa*
7 77,
A
ma
AS
jZA
mm
AV
govo;
m?
Pw

�t Q
AJ
fa
fy

NC Division/ of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date:
General Permit #: ;W12P
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 ❑ Fil�k Both ❑ Other ❑
DredgeA- FiAl Both -A 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 ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised: 02)03/10