Tuttle, Wes

LJCAMA / I— DREDGE & FILL _ NO. 73976 }
GENERAL PERMIT ,. r`J I�rI 1')�'/'�I Previous permit# A B
❑New ❑Modification i,LJComplete'Reissue % [-]Partial Reissue Date previous permif 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 ! �r ( l Rules attached.
Applicant Name (j . % (J / LF'
Address
City %LrL-wr, !>>lI5 State 116 ZIP -7,r /
Phone # ()` y� r/, !��ZMail
Authorized Agent // �
Affected El IS.EW gPTA ❑ES ❑PTS
AEC(s): ❑OEA ❑ HHF ❑ IH ❑ USA ❑ WA
❑ PWS:
ORW: yes //40 PNA yes /rno
Project Location: County lam_
Street Address/ State Road/ Lot #(s)
Subdivision
Cityi; /( rac ZIP
Phone # ( ) River Basin a t< '!
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Agent or Applicant Printed Nartv,
Signature" Please read compliance statement on back of permit
Application Fee(s) Cheic
PermitOffcer' Printed
/Name
Signature
7
IssuingD'at� E piration ate