Bender, Phillip

-'CeAMA / ❑ DREDGE & FILL
w GENERAL PERMIT
(]New ❑Modification ❑Complete Reissue ❑Partial Reissue
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
K-1 No. 73306 A B (C ♦ D
Previous permit #
Date previous permit issued
Applicant Name f it 1 I I I i t F'/1 1( �' Project Location: County
© Rules attached.
I �y
Address 1 ` `� �Gl N I I;l (' Street Address/ State Road/ Lot #(s).-
City E' f: (� State _ ZIP
Phone #, OE-Mail --
Authorized Agent
Affected El CW ❑ EW ❑ PTA A ES O PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑WA
❑ PWS:
ORW: yes / no PNA yes /'no'
Subdivision a
W ZIP
Phone # O River Basin
Adj. Wtr. Body / °('-(A C '� f natY man unkn
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Agent o Appil t'Prin a Name
Si re re ** Please read compliance statement on back of permit
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Application Fee(s) Check #
Permit Officer's Printed Nam
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Signat ire/�219
issuing Dat " Expirationate

USPSMCMG# i
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9590 9402 2370 6249 0375 60
United States
Postal Service
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
ender. Please print your name, address, and DPW in this box*
i(6 &Mer
5-" W.a,r be
4avelois,4 A/ a �4 3 z
to Complete Items 1, 2, and 3.
® Print your name and address on the reverse
so that we can return the card to you.
® Attach this card to the back of the mailpiece,
or on the front if space oermits.
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pkifpcelvecl wniftev Name) + I C. Date of Delivery
13l5deliv ry address dift§ Bent from item 17 ❑ Yes
ff-YES, nter delivery address below: ❑ No
3. Service Type
❑ Priority Mall Express®
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9402 2370 6249 0375 60
❑
Certif9590
IJ Certified Mail Restricted Delivery
Depistered
livery
❑ Return Recelpt for
❑ Collect an Delivery
Merchandise
Z. Article Number (Transfer from sarvice rahan
❑ Collect nn Delivery Restricted Delivery
EI Signature Confir,em[OnTM
7018 0040 0001 0849
5438 tll
❑ Signature Confirmation
A Restricted Delivery
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt