44958D - Henderson

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�CAIVIA/VpREDGE & FILL
3ENERAL PERMIT Previous permit#
*Jew Modification ❑Complete Reissue _Partial Reissue Date previous permit issued
rized 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 ki' )'Ce
1 Rules attached.
t Name �o E �a� �5 ^-�E . Project Location: County flay .-J
L oc
t)OC) W! k M T-r l; 0 a K- S Street Address/State Road/Lot#(s)
'NG4.-5 ..avi1.1-c StateiJe - ZIP IBLI6( )Li) 13GL aoZ '-T`C ii..„. 1
•(_ ) Fax#( ) Subdivision
ed Agent A%JIM *)JfiT- NlN\(-INC City S►0E4-\b3 �r,.` 0_111 ZIP Z/%-r)1L
Li CW CAW ` PTA ' S El PTS Phone# ( ) River Basin 1/ Mjl i b'
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body r\1:5013 L V- 1./ A\-) /I
❑PWS: ❑FC: \
yes /1 )1 PNA ©e / no Crit.Hab. yes / no Closest Maj.Wtr. Body ,V IT-- t/cl1
Project/Activity 1- -S1 L 4- t 'V .c• ' • V v./ 01 C it v , P 0..... 0 C
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ck)length I
i(s) 1 . . __.... ! 1
ier(s) , . 1 {— I ngth :__. }
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mber
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0/Riprap length ..S 3 i ..
distance offshore 1-
uc distance offshore 'L i _
ill '
iannel I
sic yards - ;
1
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ulldozing --0.- '..„,..„
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not sure yes no
.._ ._- .r ... ...... i s: not sure yes
Vi
•ium: n/a yes n L-' EX - 1. .._- _ I ... _ ! ... l._..yes n1M1Lc i
kttached: yes ' ,
ng permit may be required by: ©15 L.- J Le.) (-//-'v n See note on back regarding River Basin r

M14'
5406
TINORI CONSTRUCTION BANK OFAMERICA
135 VIRGINIA LANE
SNEADS FERRY, NC 28460 66-19/530
[phone] /.3 J J1N 0
C. 0_ E i.1. $ 3cb• c
O 4eiA9 DOLLARS
2 ICI
7 1-416.-5
7-2 - ,5 2_e4z/.;i4.1_
AUTHORIZED SI ATURE An de ry S.
11.005406116 1:053000 L961: 000 6 50 5 2 1 9 9011'

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I, give authorization to
A in ri arine Construction to act as the
contracting agent in obtaining and signing for the
requested CAMA permit.
Job site addre§s is:
14 c IS, l i f0,4, -1;,(
Sine,-c(s C=� ,, ,,,7 11 _C ,2_ 44 o
My permanent address is:
boo ( ) 11'-f Oct_ I S
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