43371D - Bayshore

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XAMA/ .r"DREDGE & FILL
3ENERAL PERMIT Previous permit#
'New 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 )H- Y 1
❑Rules attached.
t Name 1 ' 4...0 rl 0 f Project Location: County D(sJs 1.. L.,..,..)
Oj c 3' v../.. !..._ Street Address/State Road/Lot#(s)(Gam rcl.
ICirNLA.\*.AD__5 Stater)L. ZIPQ.S7', 1 c7 `‘LOc.►L t-\C_4:1; y
( ) Fax#( ) Subdivision -6 Ayc H3ti6*
:edAgent tG12-K-y E A20. City rkbS c-E./2 ✓. 1 1 ZIP -3L!(•
CW ❑EW ❑PTA 7ES ❑PTS Phone# ( //) • River Basin W h?j G
El OEA HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body�,...t1+ vJ�G 11— 11> - --- nat/i
°,
❑ PWS: ❑FC: A..L ✓W. F
yes / PNA yes / CD Crit. Hab. yes / no Closest Maj.Wtr. Body
'Project/Activity L i-.)3-1" A u- L L'1A.?c vt\n.- F,= C T o G i•,.. \\ .
(Scale: I n i
ck)length
i(s)
ier(s)
ngth
mber -
d/Riprap length tic''
distance offshore
ix distance offshore al I .__.
iannel
Di yards (1 F-I`O a.. t...._.
3u(�
Ise/Boatlift j -
ulldozing
e Length '* !
yes no \„ - �
s. not sure yes no `. . ,)
ium: n/a yes P 1
yes
attached: yes —
ng permit may be required by: C.t3S1a C I See note on back regarding River Basin r

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SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signetute
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse X / ♦/ ❑Agent
so that we can return the card to you. I '`4�❑Addressee
• Attach this card to the back of the mailpiece, B. Recgived b (Pd .:,•y _
or on the front if space permits. C. Date of Delivery
1. Article Addressed to: D. Is delivery av•dress cl'' _ : from Item i? Yes
If YES,ent del pyress below:
3. Service Type v�
❑Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee)
2. Article Number ❑Yes
(Transfer from service I 7004 2890 0003 7346 1440
PS Form 3811,February 2004 Domestic Return Receipt
102595-02-M-1540
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Sig -
item 4 if Restricted Delivery is desired. 0 Agent
■ Print your name and address on the reverse /� /� Addressee
so that we can return the card to you. B. :1 iv by(Printer! ame) C. Date of Delivery
• Attach this card to the back of the mailpiece, .ram
or on the front if space permits. /lv Se �� �;J
1. Article Addressed to: D. Is delivery 421,04(9Iff from item 1? ❑Yes
If YE7S,, delivery below: ❑No
T C`
°Cj24 o •
0
3. Service \\\\\\
per,
❑Certified Express Mail
❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number — -
(Transfer/romsery 7004 2890 0003 7346 1433
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