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VAMA/ J,DREDGE & FILL V `
3EN ERAL 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
;oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC ) . 2`'a
❑Rules attached.
t Name VA-f H(Le, sue) Sc.H vs/A Nbi{ Project Location: County ©NS L,o�
Street Address/State Road/Lot#(s) >Fia L�,uT�Z
State ZIP j,oT L a A6 t A Lua4., 1r
' ) 'f 1L-oh 60Fax#( ) Subdivision ed Agent c\I. A t ►-�-i 5 City st.)E-411)5 CB R-Q.i ZIP IS-( I.
Cw /NEW f PTA ❑ES ❑PTS Phone# ( ) River Basin O
OEA ❑HHF ❑IH UBA ❑N/A
Adj.Wtr. Body NW � nat /r
PWS: ❑FC:
)yes no no PNA yes Crit.Hab. yes / no Closest Maj.Wtr. Body j I/V
Project/Activity !i• STD L L $0' o 6,f1-Ea -.�✓w-� C L. .
(Scale:
:k)length _
(s)
ier(s)
ngth
Tiber
1/Riprap length
distance offshore
x distance offshore yo' AAX
cannel
)ic yards
•
se/Boatlift i5 1�njf
JIldozing 1 j
c
Length r
not sure yes
;: not sure yes
cum: n/a yes dip
Yes
ttached: yes ®
ig permit may be required by: 0)S C" ' See note on back regarding River Basin rt

a
r
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signat C R NL
item 4 if Restricted Delivery is desired. X /V �G\� nt
• Print your name and address on the reverse G ❑M•
so that we can return the card to you. B. Received by(Printed ame) C. Date of Delive
• Attach this card to the back of the mailpiece, MAY �� �I"`
or on the front if space permits. �o
�L-
D. Is delivery address different from item 1? Yes
1. /Artiicle Addressed to: If YES,enter delivery ae dress below: ElNo A.
Je6 ai. / --ci--'
7 LC /� USF
*ell
3 % 3. Service Type
r
fqi-/9.,c,e,/ /c)C ❑Certified Mail ❑ Express Mail
4 0 Registered 0 Return Receipt for Merchandi:
'//� 5 ❑ Insured Mail 0 C.O.D.
vim` l 4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7004 2890 0003 7344 3279
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1;
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