56612D - Mitchell

;.AMA / J,,DREDGE & FILL
i E N E RAL PERMIT Previous permit #
dew Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ted by th*state of North Carolina, Department of Environment and Natural Resources �1 I .
>astul ResouF{ s Commission in an area of environmental concern pursuant to I SA NCAC "
/1
A 1 ITT u � 1 ` Rules attached.
Name , t' ___ Project Location: County �i�S( bW
Street Address/ State Road/ Lot #(s)
State _ ZIP ��5 W 1�VIAIV
Fax # (_ _) Subdivision A
�. ci 5 Y� zip
d Agent ---- - - �,
cw Ew L� PTA L ES ❑ PTS Phone # Nu River Basin
OEA -1 HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Liu i� Y'In at n
PWS: ❑FC:
es / no PNA des / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Project/ Activity
k) length
w(s)
gth
fiber
/ Riprap length
distance offshore
c distance offs �-
nel� A
W r_ u (0 e i
is Yards 5
p
;e/ Boadift
dldozing
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yes n\
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attachedes: no!
�s
ig permit may be required by: ❑ See note on back regarding River Basin r
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Certified Fee
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��•15 01A2r`2011
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Total Postage & Fees $
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PS Form :0r August 2006
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PS Form :,r August 2006 See Reverse for InstruLtions

JSPS - Track & Confirm
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Label/Receipt Number: 7009 2820 0000 7399 4541 ---
Expected Delivery Date: January 14, 2011 Track & Confirm
Class: First -Class Mail® Enter Label/Receipt Number.
Service(s): Certified MaiITM
Return Receipt
Status: Delivered i y'y
Your item was delivered at 1:53 pm on January 15, 2011 in COLUMBIA,
SC 29210.
Detailed Results:
• Delivered, January 15, 2011, 1:53 pm, COLUMBIA, SC 29210
• Arrival at Unit, January 14, 2011, 8:50 am, COLUMBIA, SC 29210
• Acceptance, January 12, 2011, 11:45 am, JACKSONVILLE, NC 28540
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Label/Receipt Number: 7009 2820 0000 7399 4558
Expected Delivery Date: January 13, 2011 TraCkididiim
Class: First -Class Mail® Enter Label/Receipt Number.
Service(s): Certified Mail'"
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Status: Delivered Go>'
Your item was delivered at 4:22 pm on January 14, 2011 in
HAMPSTEAD, NC 28443.
Detailed Results:
• Delivered, January 14, 2011, 4:22 pm, HAMPSTEAD, NC 28443
• Notice Left, January 13, 2011, 9:10 am, HAMPSTEAD, NC 28443
• Arrival at Unit, January 13, 2011, 9:04 am, HAMPSTEAD, NC 28443
• Acceptance, January 12, 2011, 11:47 am, JACKSONVILLE, NC 28540
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Division of Coastal N19t, Habitat Impact Computer Sheet
ilicant: �/la M'Permit #
of 51.eb I I
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
1 Qb
M
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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'3/2011 13:34 FAX [phone] ONSLOW CODE ENFORCEMENT
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3/2011 13:34 FAX [phone] ONSLOW CODE ENFORCEMENT a003
dale Iterm 1, 2, and S. AL-o complete
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