Reynolds, Emmett

LAMA / ❑ DREDGE & FILL No. 73931 A B (C D
GENERAL PERMIT Previous permit#
❑New ❑Modification JWComplete Reissue ❑Partial Reissue Date previous permit issued yi
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
Ll Rules attached.
Applicant Name /`, l,._ !`,i Yil%'!') Project Location: County„ _
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Address
City fl /TState 'l, r(, ZIP
Phone # (i) !.)'j /% E-Mail
Authorized Agent j ! / . , l.'r; !i f / -,,/<',
Street Address/ State Road/ Lot #(s) ,
Subdivision
ZIP
Affected DIM Ci.EW , Q PTA [IES ElPTS Phone # (—),,—,River / Basin
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
ri-.-.t Mei Wer Rn,Av i
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,Agent or Applicant Printed Name
Sig ature •r Please read compliance statementifn backofpermit"
Application Fee(s) Check #
Permit Officer's Printed Name _ (4JJ
Signature
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Issuing ExpirationDate