City of New Bern

�]CAMA / ❑ DREDGE & FILL 1 NO. 75253
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GENERAL PERMIT Previous permit#
Ill New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC > o
V Rules attached.
Applicant Name �( ( I( t ' +_i E' Project Location: County' 1
Address � l � f � � ,, •/ ' � j 1 _ Street Address/ State Road/ Lot #(s)
City ' / i • State C ZIP
Phone # ('- ) ! 7, E-Mail Subdivision
Authorized Agent
Affected LlCW _[NEW 0PTA El ES 0PTS
AEC(s): OEA ❑ HHF ❑ 11H ❑ UBA ❑ N/A
❑ PWS:
ORW: yes ( no ; • PNA yes /'nti�
City - r, ZIP
Phone# O River Basin_
Adj. Wtr. Body .� - `!, WV _ (nat /man /unkn)
Closest Maj. Wtr. Body j !'
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Agent or Applicant Printed Name Permit Officer's Printed Name f
Signature " Please read compliance statement on back of permit's' Signature. /
(
Application Feels) Check # Issuing Date Expiration Date