Jung, Jeannie

❑CAMA / ❑ DREDGE & FILL j No. 73956 A B C D
GENERAL PERMITPrevious permit#
❑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 I'5A NCAC
❑ Rules attached.
Applicant Name _ _ _ Project Location: County__,_
Address �- ' I /% _ Street Address/ State Road/ Lot #(s)
I •i 1 r . � - C 4�1 , State1__ ZIP
Phone # f <'
Authorized Agent
El CW
Affected
EA
AEC(s): ❑o❑ PWS:_
ORW: yes / no
❑EW ❑PTA 151l - LIFTS
❑HHF ❑IH ❑UBA ❑N/A
PNA yes / nd
Type of Project/ Activity
Pier
Fix.
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Fing
Groi
Bulk
Basi
Boat
Boat
Beac
Oth
Sher
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Mor
Phoi
Wai,
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Cii Z ZIP
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A building permit may be required by: V L(\ t `. \ I � [?See note on back regarding River Basin rules.
( Note Local Planning jurisdiction), /
Notes/ Special Conditions 1 �- / ' �'� /{ t p �'�Ol � Pr t�l t; /�,•/t -� � F i�l :-��iii t �r-,il1-%,%
i
'.Agent or Applicant Printed Name
Signaffurey�**" Please read compliance statement on back of permit"
Application Fee(s) Check #
PermitOfflcer's Printed
s. /
Expiration Date