53130D - Farbolin

,LAMA / DREDGE & FILL ,I.' o3
IENERAL 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 1 k , C C O
;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC "� J
i �- i` ` ' a ul s attached.
:�N)ame Cart)t F ✓ )13(1(S 0 1)I I (+a 4 Project Location: County 1\1€VA) to O�
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�HkbLJhHN ill: NUV U4 'Uri 1 U :423 NO .UU1 f .U
11/03/2009 15:59 p139 P. 001/001
ENR
678A
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Masa F.Enlay,cttovemor JaMaa N.Gregson,Director Wpm G.Ross Jr.,Secretary
Date I1 o3 LoG
Name of Property Owner Applying for Permit:
eis.rcA f
Melling Address: c jo c b o\,r, 'err.
QoX 0400
r\o r c.OD s (} A 3 o o t p
1 certify that I have authorized(fit)itsaeSl$ ivi's • to act on any
behalf,for the purpose of applying lbr and obtaining all C 4.MA Permits necessary to
install or Construct(activity) rr o i
at(my property located at) IL C a rrt��r Ro. c; Afg
This certification is valid thrn(date) 1 a\3
Arip-e //- -off'.
Property Owner Signature' Date