66699D - Farrell

AMA / DREDGE &FILL
3"ENERAL FT,,RMIT 1� (� Previous permit #
fv L Modification omplete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North ling, Department of Environment and Natural Resources —7 ! •' �,
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ( l
L Rules attathh
if Name l Project Location: County
Street Address/ State Road/ Lot #(s
• 1LkV State ZIP U la�v
ail VY (f[�q AN Subdivision
McAAV�a
:ed Agent ! - vl City L % % kY 11 ,) _ ZIP_.
6QCW PTA ES ❑PTS Phone # ( River Basin {
f❑ OEA ❑ HHF ❑ IH ❑ UI&A ❑ WA �, �(�
Adj. Wtr. Body - F n
❑ PWS:
'- *1 Closest Maj. Wtr. Body
yes / no PNA yes no
ck) length_
atform(s)
Platfortti(s)
ngth
mbar
d/ Riprap length
; distance offshore
ac distance offshore
cannel
sic yards_
np
ise/ Boatlift
a Length V— i Ii i i T
I i
not sure yes
I �
ium: n/a
yes ' no L .
lttached: yes Cn.
_ I
-ig permit may be required by: ~
Local Planning jurisdiction)
t--)) I t-! c 1 -.. 1 1_
($tale:
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note on back regarding liver tSasin n