Prove, Mike 78836C

-� CAMA / El DREDGE &FILL NI? 78836 A B D
GENERAL PERMIT Previous permit
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
Gd
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC d
TrX Rules attached.
Applicant NameM �ael/b Project Location: County �� )�/
Addressc A V hF) VStreet Address/ State Road/ Lot #(s)
City J 11 r Statd_ A/CaP � (J
Phone # MAP) E-Mail Subdivision
Authorized Agent Pr L CP ii ��. City ZIP
Affected ❑ CW PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body na an /unkn
❑ PWS:
ORW: yes / no PNA ye / no Closest Maj. Wtr. Body
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
or Appl
L V �—QLALD ❑ See note on back regarding River Basin rules.
Si atur � r�Please read compliance statement on back of permit
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Fee(s) Check #