Adkins, Charlie 78828C

CAMA / 'J DREDGE 8e FILL
GENERAL PERMIT
WZIL�New 1]. Modification CComplete Reissue 1� JPdrtial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in are area of environmental concern pursuant to 15A NCAC
Applicant Name
JAB .....�.
Address (7 I / C i �-;PV(?id F 1, N Q fAi
City.�� �11 Cl�State C.'ZIP
Phone # } �� �' ' . E-Mail
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AuthorizedAgent , �'l..��,✓� �' �(0'ot��.�'-
AffectedAEC(s):
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❑ OEA
❑ P:
yes Cno
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PNA ryes -) no
type of Project] Activity 1)� 0P.-C.�
❑ PT
❑ /
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78828. e) D
Previous permit
Date previous permit issued
-Rotes attached.
Pro-ect Location: CountyT ( ;�
Street Address] Stale Road/ La* #(s)
Subdivision.
its _} ZIP
Phone# Piver Basin _
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Waiver Attar h e = n r -: .v _.i... f. _�, T= F � .. ..
building permit may be required by. .��� - - - See note on back regardinp, River p- Basin rules,
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Al
•_•-- ------
S-ionature P lease read compliance statement on back of permit
ication Fee(s) Check
Permitd€ficer's Prinied Narrv�
Sign ore
IssAing DAte
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