Maritime Siblings

QCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
LNeW ❑Modification []Complete Reissue PPartial Reissue
No. 75005
Previous permit # / %
Date previous permit issued
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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 �' '`' Project Location: County
Address % Street Address/ State Road/ Lot #(s)
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Phone # O
/ E-Mail
Subdivision
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El PWS:
Closest Maj. Wtr. Body -
ORW: yes / no
PNA yes / no
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Signature -I Please read compliance statemerr(t on back fpermit**
Fee(s) Check#
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PermitOfficer s Pdted Na ne,
Signature-
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Issuing a e I Expiration D, to

AMA / O DREDGE & FILL yG�/ N2 71690
L�JMNERAL PERMIT
New ❑Modification ❑Complete Reissue
As authorized by the State of North Carolina, Department of
and the Coastal Resources isslonln ga1nt re of a vl°t�n
Applicant Name rfll' ts`+It
Address O _
Ow �{A'1?i. - �" StateN C ZIP G
Phone # (t
Authorized
AAffected DCW i"W .RKA DES ❑PTS
Affecte DOFA OHHF DIH DURA ❑WA
PWS:
ORW: ves /)no PNA )es no
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Previous permit # --C�
❑Partial Reissue Date previous permit Issued
Ironmental Quality 'Iff
tal concern pursuant to ISA NCAC
ORpples attached, x .
Project Location: County C.:��`�TC9" .11 t4.''
Street Addres^s/ State Road/ Lot #(s)
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Phone # (_) River Basin
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Waiver tached: Y.
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building permit may be required by:
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LJ See note on back regarding River Basin rules.
(Note Local Planning jurisdiction)
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p�lkant Printed
Signs el Pl aseread COmpllanc statementon ackofperml ie
A pllcatlon Fee(s) CheckB

■ Complete iteme 1, 2, and 3. Also complete A.
Item 4 if Restricted Delivery is desired. % tent
.. tea✓ ❑ 2.
t III IIIIIIIIIIIIIIIIIIIIIIIIIIII IIII�I IIIII�III 0. edeived by Orrinted Name) '11a De
D. Is delivery address different from item l? Yes
1, Article Addressed to: If YES, ehter deliveryaddress below: No
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3. Service Type
JXCertified Mall° ❑ Priority Mail Express'
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ Collect on Delivery
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Numbrfrom s7014 0150 0000 4788 3372
(!rensler from service label)
PS Form 3811, July 2013 Domestic Return Receipt

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