McLaughlin, John

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CKCAMA / ❑ DREDGE & FILL N9 78450 C D
GENERAL PERMIT Previous permit # 7^81
❑New ❑Modification .©Complete Reissue ❑Partial Reissue Date previous permit issued
i
As authorized by the State of North Carolina, Department of Environmental Quality i / - ,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / -
Rules attached.
Applicant Name I r j) Project Location: County
Address
City f.
Phone #
Authorized Agent
1 State N ( ZIP -
5- 7�77E-Mail
Affected71 CW LRIEW 2 PTA ❑ES ❑PTS
A
Affecte ❑0EA ❑HHF ❑IH ❑UBA ❑N/A
Q PWS:
ORW: yes / no PNA yes / no
Street Address/ State Road/ Lot #(s) " , <.
City ZIP
Phone# O River Basin I !r ! (i
Adj. Wtr. Body Pir (nat'/man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
PermitOfflcer's Printed Name'•
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Signature f
Issuing Date r Expiration Date