74250D - Hill

! CAMA / ❑DREDGE & FILL NO. 74250
GENERAL PERMIT Previous permit # A B C
New ❑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 b % 14 . 10- ca
❑ Rules attached.
Applicant Name -D Av ID N 1 u.
Address '13 o 6 gr_ygV I LLr_ Igwn S E
City C79_M.4VJ"r_ State ./�/C ZIP 278198,
Phone # (2S2)714- 7244 E-Mail �I�A
Authorized Agent /J /A
Affected ❑ Cw XEW )(PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /" no PNA yes k1i
Project Location: County 11 i9 LAB/ S w i C-K
Street Address/ State Road/ L1ot� #(s) 12 3
QGLrAiv �L_, w EST 5 t+V D
Subdivision
City Ucr=m 1-.5"M ESN ZIP 29469
Phone # ( River Basin LuKX�qR
Adj. Wtr. Body J`4i Cr+l 'CAj7r-RN C►4illlll i/man /unkn)
Closest Maj. Wtr. Body 1 kaaS _L w L IE A •rl. O «wd
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Agent or ApplicarfPllill Natne
Signature ** Please read compliance statement on back of permit*
1Z00 * 2923
Application Fee(s) Check #
CAL4.1RE
Permit Officer's Printed Name
Signature
S /xo19 9�1 &�2019
Issuing Date Expiration Date

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Check
Daf¢ Received
Date Deposited Check Fru_(Name)
Name o/ Permif Holder
Vendor
Check Number
amount
Permit Number/Comments
Receipt or Relund/Realkuated
Columnl Column2 Column3
Co/umM
Columns Column6 Column7 Column8 Column9
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5 1 01 HIM Pr ,roes / D—d Hill
DaHd Hdl
I Flrst C - -k 29 3 2000 P p7425 rd 8199