Beere, George

®L CAMA / ❑ DREDGE & FILL r'v 3 �o f ?Cc NO. 74934 A B C ; D
GENERAL PERMIT Previous permit#
LlNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 7 �,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0
❑ Rules attached..
Applicant Name Project Location: County
Address f eP C+n Street Address/ State Road/ Lot #(s)
City i r^ L State /-/1 ZIP
Phone # ( r) 'LIE -Mail Subdivision
Authorized Agent
Affected 0 eW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): 00EA ❑HHF LAH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PIMA yes / no
City ZIP
Phone # O River Basin
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit/'*
Application Fee(s) Check #
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PermitOffcer s Printed Name
Si nnaat4re
Issuing Date Expiration Date