74569D - Kaznowski

'(-.�CAMA / - DREDGq & FILL
GENERAL PERMIT
❑New —'Modification /Xi Complete Reissue El Partial Reissue
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
Applicant Name �A � G1% T)i OAA G S KQZr U IM oL t
Address / 772 ?O a'm N - City_tMO`� - State r�z ZIP ?�y 7 /
Phone # 'Vf11 S - E-Mail
No. 74569 A B C
Previous permit # ( ZZ
Date previous permit issued -
15A NCAC 04,
❑ Ryles attached.
Project Location: County fg4h
Street Address/ State Road/ Lot #(s)
Subdivision
Authorized Agent
❑ CW i� EW 3pTA El ES ❑ Tone #
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS:
/ ^ t4 i�ll
AgeRlflot Apple nt Printe Na
Signature Please read compliance statemen� on b ck of permit
Z� o .11611
Application Fee(s) Check #
Adj. Wtr
ZIP
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mi fficer's Printed Name
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Issuing Date Expiration Date

Data R—ivod
Daft Deposited
Chaok From Nam*
Nam* of Prmit Holder
Vendor
Chock Num
Ckaek
amount
Pumlt Number1C—tS
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8/15/2019
8/15/2019
H5 Construction
Richard Penn Construction, LLC
Eric and Trace Schmidt
Michael Kew
Chet Willis
Tracey & Eric Schmidt
BUT
2337
$ 200.00
#74700D
#74568D
#74689D
GP #74329D
GP #74569D
BB rct. 9106
JD Mt. 8551
PA rct. 7971
PA rct. 9154
JD rct 8552
Na Federal CU
1140
$ 200.00
8/15/2019
First Citizens Bank
4070200.00
8/16/2019
Clements Marine Construction
Elizabeth Landis
First Citizens Bank
5195
$ 400.00
8/15/2019
Richard Penny Construction LLC
Patricia & Thomas Kaznowski
Navy Federal CU
1 1141
$ 200.00