City Of New Bern

®NCAMA / ❑ DREDGE & FILL No. 75025
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue 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 I SA NCAC
❑Rules attached.
Applicant Name ` / �i ]�(It,v j y.O� r„ f� �6 { `'r`Project Location: County U, r
Address 1 1 '0V f Street Address/ State Road/ Lot #(s) ! ! i c., i f. (�/ _
City/'l: .�✓ ♦'�.j->7 StateZIPS
Phone # O �; ' ��� Y(fE-Mail Subdivision
Authorized Agent r
Affected ElCW j EW OPTA ❑ES OPTS
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / n�
City /-- be— /"') ZIP
Phone # O River Basin
Adj. Wtr. Body-1 c'Y Vli/)(nat /man unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature *'' Please read compliance statement on back of permit"
(4-4
Application Fee(s) Check #