Schneider, Joel

4AMA / L. DREDGE & FILL �—No. 75048 A B C D
PENERAL PERMIT Previous permit#
nNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by iihe State of North Carolina, Department of Environmental Quality /
and the Coastal Resources Commisgion in an area of environme tal
n cncern pursuant to I SA NCAC
u
// ❑Rules attached.
//// � (
Applicant Name J/ -- S / !_ ( t✓ Project Location: County
Addressi, , Street Address/ State Road/ Lot #(s)
City States ZIP'
Phone # E-Mail Subdivision
Authorized Agent / 1/ City_
ZIP
CW d EW PTA ❑ ES ❑ PTS Phone # (_ ) -` -- i _ : River Basin
AffectedEl El HHF IH ❑ UBA ❑ N/A - I' )
AEC(s): Adj. Wtr. Body C /' _ (nat" /man /un>kn
❑ PWS:
W B d
ORW: yes /no PNA yes / no
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PermitOffcer's Printed Name
SiBn.atur
ISStlln Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent)lk
.q $ �e N e @ to act on my
behalf, for the put -pose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
4l_ /Ue ve 10 6
This certification is valid thru (date) / -- // — Z P Z O
Property Owner Signature
S Ll�" l^z_NC f'
ZI
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Date

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