67947D - Cherry

CAMA / DREDGE & FILL
3ENERAL PERMIT
Whew Modification QComplete Reissue ❑Partial Reissue
19E A B
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources I ,
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached
t Name F>' �� V (',
(50 aa,ANJ 6(v
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( ) F-x7-k f e '�� j E-/Mail
ed Agent
❑ CW EW PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
yes �/- rszs` PNA yes /Cf
Project/ Activity (:f j 1 A60—
4A ID.. 1,
Project Location: County_ j rNi%t t"--
Street Address/ State Road/ Lot #(s)
Subdivision
cityln, zip Z'�44?
Phone # O River Basin
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ig permit may be required by: 0 121 Q*Aj ❑ See note on back regarding River Basin n
-ocal Planning Jurisdiction) I

A NC DIVIS On OT `.a;ats ser.,u ;ya. anceeaaa6.s „..ate.« _ _
Applicant:
Date: `
Describe be�w the HABITAT disturbances forth application.
t found in your Habitat code sheet.
All values should
match the name,.and un!is of measuremen
TOTAL Feet
FIN
TOTAL Sq.- Ft.
(Applied for.
FINAL Sq. Ft.
(Anticipated final
(Applied for.
(Ani
DISTURB TYPEinclades
Disturbance.total
any
disturbance.
Excludes any
Disturbance
total includes.
d"rsti
Exc
Habitat Name
Choosy One
anticipated
restoration
any anticipated
rest
tom
restoration or
tamp im L acts
and/or temp
IMP? ct amount
restoration or
teMR h acts
am(
C19��
Dredge ❑ Fill ❑ Both ❑ Other }�
/ q3j -
Dredge [] Fill ❑' Both. ❑ Other ❑
Dredge ❑ Fill [] : Both .❑ other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill M. Both ❑ Other ❑
Dredge. ❑. Fill ❑ : Both ❑ other ❑
1 ;
Dredge ❑ Fill ❑ Both ❑ Other ❑

'ayment Proccessing Confirmation
)ate Received 11/23/2016
heck From (Name) Allied Marine Contractors
Jame of Permit Holder Bill Cherry
fendor First Citizens Bank
;heck Number 5106
:heck amount $200.00
Multiple Permits No
Major/Minor
'ermit Number/Comments GP 67947D
teceipt or Refund/Reallocated JD/3409D