Smith, Roger Jr.

®ICAMA / J DREDGE & FILL �-�l(� f " ! ( �; I /'`," I NO. 75050 A B /C D
GENERAL PERMIT k. , Previous permit#
P' New ❑Modification ❑Complete Reissue * DPartial Reissue Date pre viou� permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission jD an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Ngmg �' •! %) . Project Location: County I _ ; i
Street Address/ State Road/ Lot #(s)
City { State - _ ZIP
Phone #(( ) �%6 Mail
�..,. _ .
Authorized Agent
Affected El cW D E W 0 PTA ❑ ES ❑ PTS
A
Affecte aOEA F-HHF 11 IH ❑UBA El N/A
❑ PWS:
ORW: yes / no PNA yes / no \
Subdivision
City— I
Phone # (. ) River Basin
Adj. Wtr. Body (nat /man /unkn
Closest Mal. Wtr. Body—
id!
:::::■i,Vn::::::ei:::::::::::NM:�:::::
■■■■■■■■��■
won ■■®■■■ ■■■■■■■■ �_���■�■■■
■■■■■■■■■■■■■■■■■■�1■�����N....�li.®.���
■
■
IN
III
®:�
.v■■1111mummiIEN■■
:u■N
:
:■■■■■■®
■O■■■
...s=
MEMO■:II■■■■■
■■■:■E■■M■
■
■■E■■■
■■■E■■■■■M■■■■■
■■■■■■■NNSM■EOMMSNES■�EE■NENNNO
■■■■■■:■::::::�
:::::■:::::::::
::::::
:
MENNEN::■■
■
■■:
■E■
:■■■■■■■■■■■■■■■■:
:::::::
ME
IN
MEMO
■■■■■■■■■■■■■■■■■■■Mom
M. ■■■■■■■■
■■■ENE■MM■■■■ E■E
E EEM■■O■■■■ NE■SNE■IIE■■■■:E■E
■■■
:E • N■EEO OQIOOONSEEO■�■■�
■■
■■■:i:iN�:E■:�::SE■■■:NNEE■EN■M
- ■■E■E■E■■■■■MEN■■MEE■■■■■EEE■■■■■,EE�EE■■:
■■■■■ ■■■■MEN■�!
■EE■■■■EEE■■■■■EEE■ E7■■
■SEEN ■EMESEE■lKI:EiIEE!®■■■
EEEN■EEEEEVAN
ME ■■■�■■ME■E CE■■■■■E
::1
�:
■ ■■■■■■■■■■■
.■■■■■■■■■■■■5...........a....■.
:::::::.::.:...■:.:M.■.■::....::....:
. .... . ■■■■ ..■■ .■■.
■u■■■E
■■■■0■SE■E■■H■: ■ ■■■■■S■
e■■■■■..
.MEMO.■.:
■■E■■■■■ ■E■MM■.
Age t or Applicant Printed Name
Signature; Pleaseread compliance statement on back of permit"
ApplicaiionFee(s) Check#
PermitOffcer's Printed Nate
Signarlp
9

Name utProporty 0wrW Roquestmg Permit: .> SrAi7 IYd`
Mailing Address.
Phons Number:
Emao Address:
I cenrfy that I have aWxmed Avpgr Wfra,
AaeM I Gamfabar
to ad on my behalf, for the purpose of applying for and dWaWrq W CAW permits
necessary for the following proposed developmerd: u?iluirf h,mwk poele ....
1N Snn9 1;.' IFa.� vs,;�t• F,.se",,df �/Itin•Gf
at my property totaled at c 2 4,. 00r✓ '114 P ,('r A,-- it h eAeOl
in CljLr f r County
f lurthermor9 Certify that t am authonted to grant, and do in fact grant permission
Olvrsron W Coastal Management staff, the Local Permit Officer and thou agents to ant
on tfre alo nwrptionad lands in Connection with evaluating information related to lf
Permit application.
Property (emir ktfotmatlon.
9&LN—Ad
ga
Date

V j
� v) F
N 0
C4 OD
W Ol o
O co a W y C; f� N S
.Ui � b w
pxp�� na a� A ti
q a
A
p t`00
6
3 000 a Pw
LO
O H 0o oO 000 > ,a, o M
`o -zi �o
VY o
$
r{/yy� LO rn ap
rl Z co �0
v vz W F W U y' x d z A •iy ,P ?' N ry7 y�y L E
10 g kPk
° b
[� 3 N a