74792D - Foor

r.. L.CAMA / ❑ DREDGE & FILL No. 74792 A B C
GENERAL PERMIT Previous permit # 7% 6Z-
❑New ❑Modification )6Complete 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 I SA NCAC 1 ff
r / E Rules attached.
Applicant Name o�LQ� 4 G ! {� �o o / Project Location: County 1 fiU C/ck_
Address
2-k ✓, -to) /
City ri ' ,OS tk State A.)- ZIP 7
Phone #) Z — E-Mail
Authorized Agent
Affected ❑ Cw QEW )Q PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes / n'o-: PNA �!P/ no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP 4
Phone # O
( —— River Basin
Adj. Wtr. Body �/ `� nat man unkn
Closest Maj. Wtr. Body l la' t.P
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i
IIIWAS
ICl/'
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Rent or Applicant Printed Name
Y
Signature ** Please read compliance statement on back o�Permit **
Application Fee(s) Check #
�4" (_�
P itoffi is Printed Name
Signat e
Issuing Date Expiration Date

Data ROCWvod
Oats
Check From ama
Nama of Permit lloldw
vMtda7
Chock Number
Cbaok
amount
Permit Number/Cwnments
Roc@W w Ralund/Reall—fed
Columnl
Coke 2
Cokmx 9
Colu-4
Coklmm6
Colo-6
Coh-7
Cdumnd
Column8
11/26/2019
11/26/2019
Robert and Barbara Foor
same
Surdrust Bank
3543
$ 200.00
GP #74792D
GP #74704D
JD rct. 9438
11/26/2019
1126/2019
Carolus Buildina Co
Dennis Rambart
First Bank
1407
200.00
JD rct. 9437