56570D - Hagood

CAMA / ❑ DREDGE & FILL
"ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources �2061
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
[Aft attached.
Name s/ice 7�% �i �,�d L� _ Project Location: Countyc�.✓S �✓ �C�i
Street Address/ State Road/ Lot #(s) ,3d 6,,,� .
A��c 2�19.1 State------
(L1 "li'Z Fax # ( )
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zip 1
❑ CW DEW ❑ PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
city I )o / o�� ,, zips
Phone # ( ) River Basin Z W'V i
Adj. Wtr. Body ,�/'eyA" �n
Closest Mai. Wtr. Body '-�7 /
(es / no PNA yes / no Crit.Hatb. yes / no `
Project/ Activity /�/" �c ✓ 7 7 L "0 T ✓ e
(Scale./ 'L
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ig permit may be required by: A19 Lc/P-' 6D.4C `j ❑ See note on back regarding River Basin rn

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Permit#:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
id 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 fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
47 Y Y—
Y�
Dredge ❑ Fill ❑ Both ❑ Other
/ 2
3/
Dredge ❑ Fill ❑ Both ❑ Other
2 �
2�
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 0 Fill ❑ Both ❑ Other ❑

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HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN
910-842-9732 HIS NCDL 4576438 HERS 5202642
1502 STONE CHIMNEY RD SW
SUPPLY, NC 28462 _ , J Sl
W, 'CAMPW
GP5651c)(a*2
y,��,1, y, NC 2N ,
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,in 53 L L 2 15 210-80001S753011'
q 66-1215/531
840
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