56552D - Hendrix

!LAMA / P DREDGE & FILL
1"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 ^ /'
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
LRUles attached.
It Name1411F
hi 1%C'1
State AC— ZIP
Fax # ( )
:ed Agent
d CW SEW ❑PTA DES ❑ PTS
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
: PWS: ❑FC: _
yes / no PNA yes / no
Crit.Hab. yes / no
Project Location: County Kz- C/.✓s �f'// CA-,'
Street Address/ State Road/ Lot #(s) // / %C/,✓i
Subdivision
ciZIP 2 p/
Phone # ( ) River Basin L. iv,
Adj. Wtr. Body Cie^,4 [ �'-4n 061/1- v (nat
Closest Maj. Wtr. Body ,y,�/�✓
A Project/ Activity Z.9 C-P S-y" , �_ t /� , � � � , � �i L 1i/I -e9 v
(Scale:
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ling permit may be required by: 110 [7 // 13 Q/,o n4 El See note on back regarding River Basin i
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ant: ,%%,a�f)2i Permit#: C / � 2
21 ylo
;vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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 fina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
r^
>
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
C�
�O
Dredge ❑ Fill ❑ Both ❑ Other
/ J
S (I
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
El
Dredge ❑ Fill ❑ Both ❑ Other El
Dredge ❑ Fill ❑ Both ❑ ❑
Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

HOLDEN DOCK & BULKHEADS
GREGORY A &
pOROTHY HOLDEN
910-842_9732 HIS NCDL 4576438 HERS 520264
j502 STONE CHIMNEY RC) SW
SUPPLY, NC 28462 N
/ r
3787
66-1215f531
640
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2
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