37806D - Fontana

i"CAMA/ i1 DREDGE & FILL
3E1NERAL PERMIT Previous permit# `._.
Zlev` /A1odification -Complete Reissue ❑Partial Reissue Date previous permit issued —"rized by the State of North Carolina,Department of Environment and Natural Resources
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:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC , ;
5T�� ❑R�Fs attached.
t Name b'JTi�1 J Project Location: County NI E� 71iJO600---
Street Address/State Road/Lot#(s)
ft WO(► TD13 State ►JC ZIP r$4 aq Lot Z
{ I•J Le T_ PT (( k;
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( )�f 76'Co6(0 Fax#( ) Subdivision ( NU-6 T FT
ed Agent M. ( CONACP City NW l G Usk I 0 6,1O'1 ZIP 1". 5'4-I
=CW /k EW PTA ❑ES ❑PTS Phone# ( ) —r.. River Basin I �.if
❑OEA ❑HHF ❑IH ❑UBA ❑N/A L6T P T t30A-T i9N nat
❑ PWS: ❑FC: Adj.Wtr. Body (nat
� noClosest Maj.Wtr. Body PA till-TIE �Q''�
yes /iv PNA yes Crit.Hab. yes / no / I
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ck)length
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ier(s) ! • —
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s: not sure yes no _ i
ium: n/a yes no Yr''-` I . . , D� � V .. ......
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ig permit may be required by: eiW ©�-E/t I ,See note on back regarding River Basin rt
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GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: . 7 eVI � �
ADDITIONAL NAMES: NI I (Le C n ti -r
AEC DESIG: 1: i r( DEVELOP AREA: Z---o ` 7 PROJ DESC: -
(Will only take 6) ---- (Will only take I)
WORK: 177 -l , I
(Will only take 4)
MAINT:
(Will only take 4)
IMP: e) (J3 /32,
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: Z v9
CAMA MAJOR DEVEL REQUIRED:

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