Whitley, Ray

❑CAMA / ❑ DREDGE & FILL NQ 78411 A B C D
GENERAL PERMIT Previous permit#
FINew ❑Modification [-]Complete Reissue ❑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 {
/ ❑ Rules attached.
Applicant Name ii °�/ II1" i f ( Y Project Location: County
Address �`(� iaF'?F f 1 I i Street Address/ State Road/ Lot #(s)
City IiEA o State C ZIP
Phone # ( ) '�r' C, ,�E-Mail Subdivision
Authorized Agent CityZIP
Affected OCW SEW ..}PTA ❑ES ❑PTS Phone# O River Basin
AEC s : 00EA ❑ HHF ❑ IH ❑ UBA ❑ WA Ad'. Wtr. Bod ���'-+� "F.
❑ PWS:
Closest Maj. Wtr. Body
ORW: yes /no PNA yes / no
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Permit Officer's Printed Name
Signature /
Application Fee(s) Check #
Issuing Date
Expiration Date