Dickinson, Tom

®DCAMA % ❑ DREDGE & FILL � � (NO. 73390 A B /C) D
GENERAL PERMIT Previous permit#
❑New []Modification ❑Complete Reissue Partial Aeissue 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
-- —� ❑ Rules attached.
Applicant Name j ( } Project Location: County
Address Street Address/ State Road/ Lot #(s)
City_ ._ State ZIP , ) -_
Phone # O- E-Mail Subdivision
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Authorized Agent {-_ - I IJ i( t
Affected ❑CW qkW TA ES ❑PT
AEC(s): ElOEA ElHHF ❑ BA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
City
ZIP
Phone# O- - River Basin_
Adj. Wtr. Body — _- _ _gnat ]man /unkn
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
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Signature •. Please read compliance statement on back of permit,"
Application Fee(s) Check #
PermitOfficer's Printed Name
Signature
'Issuing Date Expiration Date

Blue Water
MARINE CONSTRUCTION
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RECEIVED
JAN 16 2019
DCM.MHD CITY

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