40496D - Dennis

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0.CAMA/ DREDGE & FILL 1:'V 9 4
I FNERAL PERMIT Previous permit#
ew 'Modification JComplete 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 15A NCAC 71/. AD 0 0
T L attached.
t Name ( QNN c-e /AA.6 S M S Project Location: County ZikgJC/c
170 r'ni N k /61A) . II /, Street Address/State Road/Lot#(s) 561,....o
,'Ow � Bac State �0 ZIP � b 7
( 0) t,'")9-vg,3 Fax#t( ) Subdivision
ed Agent to City OC E, A/ Scle a/ I-f ZIP J( t�
❑Cw / VITA ❑ES ElPTS Phone# ff/C/) �7 ,-4 7'2 River Basin/ irt
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS: ❑FC: Adj.Wtr. Body 1.4. k1 /r
An
yes / PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. BodyL✓w
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Project/Activity 4 i.- �n. 64- &Al Lip 1 10 G Xisf)n y
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x distance offshore
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s Boatlift /3 /`�,3 (� ��L
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not sure yes ®/ �-..., �,�...—�'`�
. not sure yes NO
urn: n/a yes a
yes a
ttached: yes a
ig permit may be required by: OC A' /r t -e 41 �I See note on back regarding River Basin ru

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