HomeMy WebLinkAbout75869D - LewisXCAMA /'•DREDGE & FILL
GENERAL PERMIT
>(New ❑Modification ❑Complete Reissue ElPartial 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.5 C. L, e-uj i -S
Address , ��"'►- V
City �jtF.e.+'� 1 � I'b State %•iG �ZI,P�-
Phone # (�y—�� E-Mail
Authorized Agent (g r e 0i e.r
Affected ❑ CW NEW )kPTA )<ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / (" % PNA yes / no
No. 75869
Previous permit #
Date previous permit issued
15A NCAC • (10
Q ❑ Rules attached.
Project Location: County prk /i f WIG f
Street Address/ State Road/ Lot #(s) i1 SS
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Subdivision S';� • —_YwN— — S
City �n'�Tr'� ZIP
Phone # ( River Basin F
Adj. Wtr. Body ��_i/-� lrha)/man /unkn)
Closest Maj. Wtr. Body A� W L"./
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E]See note on back regarding River Basin rules.
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S' tturey Please read compliance statement on back of permit"
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pp ication Fee(s) Check #
P &V'� b r; ylk
PermitOfficer's Printed Name
Signature
3 3b 1a02n i ---,o /Lo 90
Issuing ate Expiration Date
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date s - / � ` 0i
Name of Property Owner Applying for Permit:
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Mailing Address:
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I certify that I have authorized (agent) 0�*M,0�4 b �k to act on my
beba-11, for the purpose of applying for an�ea-L
d obtaining all CAMA Permits necessary to
install or construct (activity) u
at (my property located at) A 7 5-5- /',Yi t CYe-g.6 Dr COuto� .
This certification is valid thru (date) '5r ! ? — Z-69F-
Owner Signature
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Date
OfludMdtmi Applymig
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