53956D - Belo

'CAMA / DREDGE & FILL r-d
GENERAL PERMIT --Partial
Previous permit #
—,New-iModification _'Complete Reissue Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources �7 Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / /171 1,16 0
it Name 1C/R _ lzrz6
S YV J /7)15i2N111 "Gljt- � -
ie'< StatejYf ZIP.2 %4C7;
E(91 �Fax #( )
ted Agent rp e P[ d _CZ O.,.'A/
❑ CW ❑fW EMU E:;W ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no PNA yes /� Crit.Hab. yes / no
L�TMules attached.
Project Location: County -?,e tf^ S w,C�e
Street Address/ State Road/ Lot #(s) 1/J ..S4✓OL a
Subdivision
CiZIPZYV
Phone # (_ ) River Basin (.11np
Adj. Wtr. Body QLi�� f I w (nat
Closest Maj. Wtr. Body ky4V
f Project/ Activity /C eO ,A'.9 4 ,v yfi�+i P �UOTJb/�i�%
ff
ck) length
(Scale: %
cannel
iic yards
ip
se/ Boatlift
dldozing
Length
not sure yes
n
not sure yes
am: n/a yes
yes
ttached: yes
es-
g permit may be required by:Up,,, �j o�� [' See note on back regarding River Basin rul

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Date

09/11/2009 09:51 . 9193543849 DRAH 'JOLUhaTEER
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09/11/2009 09:51
9199544_E.4W9 DRAH VOLUNTEER
PAGE E1NLjt1NSONS 1 1AhE4:ss F7Lk
PAGE o4
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t certityst uit i have ttt�"e�riited (61Q6N o —uAi.+�. P-4 1 io sd on my
04hag, for the Hume of applying for Brno dMilining all LAMA Permits neceaesry to 1"GION or
This oQrdfleAkm 4 vald ftu (date)
Date

G ERALD BROWN 66-7143/2531
LIC. NCDL 4910124 0000091882 1 2
PH. 9108425685
510 RUFFIN LANE (�
z
PAY TO THE
ORDER OF-
3
S
G
MEMO
1:2531714301:
P 53956(8r.)
Pf,U oAtt4
000009 188 211-
DATE "� G
108 2
TJOLLARS