74568D - Willis

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-- DREDGE & FILL No. 74568 A B CRAL PERMIT Previous permit # 6
❑New ❑Modification )4complete Reissue ❑Partial Reissue Date previous permit issued /( •l/
As authorized by the State of North Carolina, Department of Environmental Quality / /
and the Coastal Resources C mmission in an area of environmental concern pursuant to I SA NCAC r%� t7
i ❑ Rules attached.
Applicant Name /j Project Location: County �C1Wr) 1--7-
Address
City i 57 f P State ZIP ,Z�-�7j
Phone # (/0) Z ' $ E-Mai
/I
Authorized Agent MEW
Affected ❑ CW )PTA ❑ ES ❑ M
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes PNA yes eq
Street Address/ State Road/ Lot #(s)
< - _-"Ary F
Subdivision
City ZIP -�'h'-1 w-4
Phone # ( �— River Basin 61-4 -
Adj. Wtr. Body (na unkn
Closest Maj. Wtr. Body
4?�a 'eyl
Type of Project/ Activity
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Printed Name
Signature ' ** Please read compliance statement on ba of ' it **
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Application Fee(s) Check #
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Issuing Date
lz -1g- i
Expiration Date

REOGE & FILL
AI TO 70564 A B C--<f:D
�., PERMIT
Previous permit #
Modification ❑Complete Reissue CPartial Reissue Date previous permit Issued
Ry the State of North Carolina, Department of Environmental Quality '/
6 7
l Resources Commission in an area of environmental concern pursuant to I SA NCAC f'�' •
Rules attached.
icant Name
_
Project Location: County —
Address Lo12D Tom'
Street Address/State Road/,`Lot #(s)
city wlL'hk IfUon 0 State NL zip �_
�04_3 ��t' /IAIArPA) 'li;w /0'
Phone # 10 ) 7-0172W E-Mail ____
Subdivision h/10_ AT drs%/-TfS
Authorized Agent (AL )U _Ale
City__.. ��� zip ��3
❑ CW
W )d PTA S $PTS
Phone # (� j �� River Basin
Affected 1-
AEC(s): ❑ OEA ❑ HHF O IH ❑ UBA ❑ WA
Adj. Wtr. Bo(nat�/unko
❑ PWs:
Closest Maj. Wtr. Body
ORW: yes PNA yes'®
MEN
■
NOON
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t-Ar Applicarn Print Name Permi Rcer's Printed Name
Ajgnaatu�re ** Please read compliance statement on back of permit ** Sign re let
Application Fee(s) Check # Issuing Date Expiration Date

Data Received
Date De .sited
Check From Name
Name of Permit Holder
Vendor
Check Number
Check
emount
Permit NumbarlCommenb:
Receipt or Relund(Reallocsted
Column!
Column2
Column2
Col-4
Col"ns
Columnscowm"r
Column9
Column#
8/15/2019
H5 Construction
Richard Penny Construction, LLC
Eric and Tracey Schmidt
Clements Marine Construction
Michael Kelly
BB&T
Navy Federal CU
2337
1140
4070
5195
$ 200.00
GP 074700D _
GP 074668D
GP #74689D
GP #74329D
GP #74569D
BB rat. 9106
JD rct. 8551
PA rct 7971
PA rct. 9154
JD rct. 8552
8/15/2019
Chet Willis
$ 200.00
8/15/2019
Tracey & Eric Schmidt
First Citizens Bank
First Citizens Bank
$ 200.00
8/15/2019
Elizabeth Landis
$ 400.00
8/15120191
1 Richard Penny Construction LLC
Patricia & Thomas Kaznowski
_
1 Navy Federal CU
11411$
200.00