Szczygiel, Jacob 78477

❑CAMA / ❑ DREDGE & FILL O
N . 78477 A e :'c; D
®GENERAL PERMIT Previous permit# "49 r,
❑New ❑Modification ,,,Complete Reissue ❑Partial Reissue Date previous permit issued 1r,- /G'---'G� "]
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 07 IVj � r"
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Applicant Name 7, Cv4 Sya1 t I
Address�ZIP
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Phone # ( )� t•�% _, E-Mail C
Authorized Agent
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Affecte 00EA ❑HHF ❑11H ❑UBA ❑N/A
❑ PWS:
ORW: yes /!no PNA yes /'6o1_'
Type of Project/ Activity;
Pier
Fixec
Float
Finge
Groh
Bulkl
Basin
Boat
Boatl
Beac
Othe
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Project Location: County C AyPrr-)
Street Address/ State Road/ Lot #(s)
Subdivision '' � i (� 'r C
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City ZIP
Phone # ( ) River Basin
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A building permit may be required by: ( 4 - t j/^ 1 Q / /` / / Y ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction) I,
Notes/ Special Conditions - -�
Agent or Applicai ai a Na e
G.
Signature z•"Please read compliance statement on back of permit"
Application Fee(s) Check #
PermitOff cer s Printed Name
Signatur
Issuing bate Expiration Date