Powers, Steven

17`CAMA / ❑ DREDGE & FILL j NO. 75066 A B C D
GENERAL PERMIT Previous permit#
dNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized bythe State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to.15A NCAC - "
❑Rules attached.
Applicant Name { o V `" " ,I Project Location: County
Address f l ! 1 1 r ?G ( l Street Address/ State Road/ Lot #(s) y`
City i \ StateJV ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent
Affected ❑ CW ElEW ❑ PTA �f:5 ❑ PTS
Affecte ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /'no: PNA yes / no,
City
ZIP
Phone # O River Basin '
Adj. Wtr. Body i�^ ( (nat_/man /unkn)
Closest Mal. Wtr. Body' ' % ` � r o