53109D - Daily

/CAMA / f i DREDGE & FILL
�ENERAL PERMIT
Previous permit #
New !Modification ❑Complete Reissue LPartial
Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment
and Natural Resources q D
- L
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ules attached.
t Name 7EkPt'W-15. DA+cwY
Project Location: County uIJax) Ili
PO 6(IV 310
Street Address/ State Road/ Lot #(s)
► iSL/i 1 State VK./ZIP Z {
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( Q) U1 41AD Fax # ( )
Subdivision
.ed Agent
City �}�C 15"A �-� ZIP
❑— ElEW ❑ PTA '❑ ES ❑ PTS
Phone # (`t t o) Z D 1 - 40 0 River Basin L-UM
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g6iA CSIHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body j�'R-1 L 1aC�C /i
❑ PWS: ❑ FC:
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yes / PNA yes / T5) Crrit.Hab. yes / no
Closest Maj. Wtr. Body
f Project/ Activity t�,�l-_l_1aOZ I N G
(Scale: = ,
ck) length
ft .
s ier( ) -- —
ngth
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mber
d/ Riprap length
distance offshore
TWY
uc distance offshore
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DTI tyle
10
iannel
fiw
tic yards
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np
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Ise/ Boadifft
ulldozing
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■ Con I ipleto Items 1, 2, and 3. Also complete
iteff 4 it Restricted Delivery is desired.
■ Prin your name and address on the reverse
so t at we can return the card to you.
■ Alte ob this card to the book of the m 7110iece.
or the front If sPaCe permits.
1, Articie Addressed to:
A. Sgnatum.
nt
x
_ Addreasgg
U. Re Wwd b (PrinW Name) G/.bato livery
1
D. Is dellvery addrM deferent from item 1? Yg,
It YES, ranter detlwry address helow: ®No

■ 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: (%
r 1 g w
� -c N3 40 AJC 2-7lk�
A. Sig lure
I1I ElAgent
V V n ❑ Addressee
B. eceived by ( Printed Name) C. Date of Delivery
.�
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
� Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7005 0390 0006 681,0 0641,
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540