57391D - McLelland

CAMA / '-1 DREDGE & FILL
3 F N E RAL PERMIT Previous permit #
Kew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of NortlliZarolina, Department of Environment and Natural Resources 7
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4 0 O
EgHGes attached.
t Name f,") C rV '/ C. L/ "77r- 7,�
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(-L� L/Fax # (_)
ed Agent -.41 PRIZ 1-t9 rs
❑ CW DEW 7, PTA DES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs: ❑ FC:
yes / o PNA yes / Co
Project/ Activity a"/L -y /
Crit.Hab. yes / no
Project Location: County 3944 rs &✓ ,c
Street Address/ State Road/ Lot #(s)-3,S`73 Ri ✓E
Subdivision
City ZIP 2 7 y�
Phone ( ) Q River Basin LW115:
Adj. Wtr. Body T/ / LtJ i✓ na_
Closest Maj. Wtr. Body 14 c
/ Z. 7 (Scale. ` ,
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ig permit may be required by: Xq ,4a ,l w 11 ea. �_, ❑ See note on back regarding River Basin rL

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pplicant: `Cz, 1,7 C
Permit #:
ate:
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
and in your Habitat code sheet.
ibitat Name
Q
DISTURB TYPE
Choose One
Dredge ❑ Fill ❑ Both ❑ Othe
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)
k '* /-'
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fi
disturbance_
Excludes any
restoration an(
temp impact
amount)
L 177
Dredge ❑ Fill ❑ Both ❑ Other
1 Ud
d Q
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 0 Both ❑ Other ❑

O'NEAL VARNAM 154419 1688
521
VOID AFTER 30 DAYS 2t8t4419
90 VARNAMTOWN RD. •
SUPPLY, NC 28462 S1�1nle
$ 20o —
lo the olyl(v— . U
62f 01 BBU
3226 HOLDEN BEACH ROAD SW c • e s , c
(SSUPPLY, NC�28462t� p�
i�uno 2L rl� 5q -,( I �kJr�, l / fya.0 r lJ_i — - ... ---
i:053LOLL20:52L8L544L911' 1688

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
hs
boy. 1qrCi
/`I,+Mz".,?L- A'C,Zj11qas-3.
A. Signature
❑ Agent
❑ Addressee
B. eived by (Printed Name) , C. Date of Delivery
Co(�;r �(2'(►
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: )251Jo
3. Service Type
J ert�ed Mail ❑ Express Mail
I El Registered El Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7010 3090 0003 0333 7735
(Transfer from service N
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
LY141
176 AA-t-h
vilIE- All"
A. §nature
X ❑Agent
'46�r __M Addressee
B. Received by (Printed Name) C. 9a)6of Delivery
D. Is delivery address different from item 11 ❑ Y&I
If YES, enter delivery address below: ❑ No
3. S rvice Type
q=ified Mail ❑ Express Mail
0 Registered 13 Return Receipt for Merchandise