38594D - Myers

❑CAMA/ ❑DREDGE & FILL !W
GENERAL PERMIT Previous permit#
❑'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
'orized by the State of North Carolina,Department of Environment and Natural Resources 7 /�
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC /� ZV!/
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// E Rules attached.
Int Namem! //'/�/�4/t/i'rl L. ��..11,,z�ye/5 Project Location: County /4/tito/ n.
s /Tc ci//%t £ 1Q- Street Address/State Road/Lot#(s) /' cc,/
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#(9/0) 2]1) —ZD/r Fax#( ) Subdivision tJaT4 -# -ce�9n Ac' cc
ized Agent City , te a•(/ ZIP -S�
d LiCw N EW in,PTA E ES ElPTS Phone# (We ) 270 -20/c- River Basin CA 0
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body C fin,/ (nat(
• ❑ PWS: ❑FC:_ ���iJj // G/
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body !'//// 64ek-
A Project/Activity A IIkc c doe.k ph 74444 R AK lea c//". i•57/),77
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ine Length > �Q� 4 X S GIJt --
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•Attached es � _ 4 i
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ling permit may be required by: Pe h de( C e n -k 7 . I See note on back regarding River Basin

GENERAL PERMIT CONFP TER FORM
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ACTION `PIRATION
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G• y► •k MALVIN L.MYERS 1910 `''
•pi ELAINE F.MYERS
Ph 910-270-2015 ee-sv�o
148 Circle Drive G.• I PO d 86-BRANCH 550004
30
` ' Hampstead,NC 28443id-ri / ante
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1111 WACHoVIA
Wachovla Bank,N.A. �A
• /n1_��ACH R/1 0.5300 219 ��yyff /`/