50273D - Fowlkes

- CAMA / DREDGE & FILL
,GENERAL PERMIT Previous permit#
',New Modification Complete Reissue Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC • J;-eU
0,11ules attached.
it Name i�(�� rs �� /t' /IJ�"f(� U W L-�t Project Location: County L* A-)
_ 1-1 _VD9.� �"�Ulk i Street Address/�SSttate Road/
�Lot
#(s)
vc,o, cL5— State_ ziF034-6o
Fax # ( ) Subdivision
zed Agent .1I6 ni (' City N ZIP
i CW E 7 EW ❑ PTA ❑ ES f _I PTS
❑ OEA HHF ❑ IH _: UBA I !N/A
❑ PWS: ❑FC:
yes(J;r�e. PNA yes / no Crit.Hab. yes / no
f Project/ Activity (`` It .
Dck) length x !Y
n(s)D X / Z'
piers)
ength
ember
ad/ Riprap length_
tg distance offshore
iax distance offshore
:hannel
jbic yards
unp
'use/ Boatlift
Bulldozing
ne Length
not sure yes -Cno
gs: not sure yes i.no
)rium: n/a yes Cno
yes Cno
Attached: yes r-o
Phone # ( F,11 M E River BasinC
Adj. Wtr. Body •�E._) /-2n l Ve1z, n
Closest Maj. Wtr. Body 'kj` .,J Al L4,/1c—
(Scalle-V/ -''
ling permit may be required by:*__&gz -(Jy/1 7�c' E See note on back regarding River Basin

40
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Division of Coastal Mgt. }habitat impact Computer Sheet
plicant: J �l f &5 � � � r
te: 3(�p//O
for the application. All values should match the name, and units of measurement
:scribe below the HABITAT disturbances
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
abitat Name Choose One
includes any
anticipated
restoration
any anticipated
restoration and/o
restoration or
. - _ _ _._.
and/or temp
........,.� -,..1
restoration or
tamn imnacts)
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
■ 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:
'b W 6,q-7-lz �-/
Z-
A. Signature
x A
❑ Agent
B. Received by (Printed Name) I an,. QfQiv_ery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: 0 No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 0960 0000 6028 8809
(Transfer from service label)
Domestic Return Receipt 102595-02-M-1540
PS Form 3811, February 2004 l I 1 —
■ 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:
/ //, A-,,.—(
A. lure � / [I Agent
v A _ (/N, / —^ `i ki Addre
B ` eceived by (printed Name) C. Date of Delivery
601t^ SGUI It' M s *?- / 7-/ O
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: 0 No

JAMES M FOVWLKES
FELICIDAD FOWLKES
NCDL 32624020
21 ASVIOVIT CT DS FERRY 1NC22B46 9432
BRA NCH BANKING
ABBT BBT.comMPANY
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