52496D - Wallace

LIC,AMA/ ❑DREDGE & FILL hl°
GENERAL PERMIT Previous permit# 5- 3//ee -,
❑New ❑Modification Lomplete Reissue ❑Partial Reissue Date previous permit issued / 0
horized by the State of North Carolina,Department of Environment and Natural Resources 7 J 7
e Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC // L7 , G a 0
[3les attached.
ant Name 4/Fez a IA/A1 L/ACC- Project Location: County (?7,Z N,-..c 41,e de
ss /1/6 9 /1/! C k'c'it y /��r cojc •e Rd, Street Address/State Road/Lot#(s) / /./Ai iG-./ .
/- i9rf4 i j ec'4s State A'C ZIP ,f (171
#( 2130f 7 9/- ?i -'Fax#( ) Subdivision
^ized Agent 7-4,1 C. Ail 47 SS City "Ci 'it' Tf Z P (1 '°4c A ZIP 2 7%
d ❑CW DEW ❑PTA ❑ES ❑PTS Phone# ( ) River Basin LL/n
): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (A,4Od L 0474/4/4/1- (nat
❑ PWS: ❑FC:
yes 12 PNA yes /,. .::-; Crit.Hab. yes / no Closest Maj.Wtr. Body ��G✓W
of Project/Activity jeer e- rT X , f 74.y /i el'5,47/9Mf�t 7 /77e,",7/JNj JGc..'1
�� )( , (Scale: /dock)length(�J V/
rm(s) / i,��, ("9 /. 1 e,,,y ,
I
•pier(s) j ,
length 17
s
lumber ; I
ead/Riprap length j i i7 r
ivg distance offshore
nax distance offshore
channel = b —,— ....___
I �
:ubic yards -Na ( '
'amp j
ouse/Boatlift - .---y — —
` C # i
Bull ng `{ �` .1 I '
i`L®A/s a --�' 1
ine Length 2 1 S '
not sure yes ion �,._ . -w- - y , . . . 1 _
ags: not sure yes
orium: n/a yes L, - - r iU Ai/a /I 1 5 ( '
s: yes 0
r Attached: yes o` i
ding permit may be required by: CC r Ats 7.-{I ' 6.p,Qc A ❑See note on back regarding River Basin
./c___:_./..__-1,2--- /0/Q .. 1 IJ'G eC., 1 - A/I �. . - - /i.- Q i / -

THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATER MARK HOLD AT AN ANGLE TO VIEW
WESTERN MONEY INTEGRATED PAYMENT SYSTEMS, INC.•ISSUER
UNION[ [ORDER Englewood,Colorado
09-058975619
AGENT 323436 DATE 030509 "-) (1n 0 P" a"4 82-40/1021
TIME 0951 27 to �� C ' "
090589756194 LOCATION 002 4b l`,'p,` ''ot **
** PAY EXACTLY TWO HUNDRED DOLLARS AND NO CENTS .***,*: U#*:*: *
PAY EXACTLY
PAY TO THE /I I(' /1 jig �
77,e/ PAYMENT FOR/ACCT.#
ORDER OF
V p�E jf/,,fit ram(
c.2 PURCn 5 0 EREO aAWEa
i � � 7 ' P,ACNA9 B E 91ONINO YOU AGREE T THE ERNS ON THE eEVEeeE 810
Western Union Money Order end Design is a service mark of Western Unan Holdings Inc/Payable at Wells Fargo BAnk -nd Junction Downtown N.A.Grand Junction,Colorado
�: LO2L00400': 1,0090589 ? 56L91.0 ' GP L 1D -