HomeMy WebLinkAboutHeath, JonathanLICAMA/ ❑DREDGE & FILL No. 74456 A B C.,` D
GENERAL PERMIT Previous permit#
JAIWNew ❑Modification ❑Complete Reissue El 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 15A NCAC
s tt j GG � �[3Rules attached.
Applicant Name �� ">s`},t f' i'FJl �1 Project Location: County f CA (VI I Gt<7
Address 10 6y o o ' crl e Street Address/ State Road/ Lot #(s) -207r
City 1 ,•,t %'..y��"�/ State j�
ZIP 7'
Phone # (`} //T+�r7 E-Mail Subdivision
Authorized Agent
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Affecte ElOFA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Phone# (} River Basin
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PermitOfOcer's Printed
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Issuing Date 5xpiratiofi Date
A
■ 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 mallplece,
or on the front if space permits.
1. Article Addressedto:
14ti,on Ask,;�s � ��(,L
1t? Z b1t, rry L.<t /.mot [—
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9590 9402 3099 7124 9922 07
2• /uncle Nt mbar �rap(erfmm sgrvisa lade
PS Form 3811, July 2015 PSN 7630-02-000-9053
Complete items3,.2, and 3. - -' "
■ Print your name and address on the reverse A
so that we can return the card to you. X
■ Attach this card to the back of the mallplece, B.
or on the front is
�r Z-�—.7ks
3d5-0 �Talfrf,s° AW
4r1111111
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IIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIII
9590� 9402 3099 7124 9921 91
PS Form 3811, JDIy 2015 PSN 7530-02.000-9053
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D. Is deliveryaddress different from item 11 ❑Yes
If YES, enter delivery address below. ❑ No
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