SeaLinger, John 78242C

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AMA / I i REDGE & FILL
ENERAL • A $
Previous permit #
New J. iModification _'.Complete Reissue _'-Partial Reissue Date previous permit issued _
As authorized by the State of North Carolina, Department of Envi ental Quality
and the Coastal Resources Commission in an area of enviro ie�cern pursuant to I SA NCAC /
Applicant Name'""t. ` , l �` Rulesa.
Project Location: County
' Q F, at _...__.._._... e
Address, — Street Address/ Mate Road/ Lot . {s}
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City , — State ZiP r
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Phone #� E-Mail .____.............. . ...... SubdJVfsion
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Authorized Agent
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Affected ; CW
PTA ES PTS
_
AEC{s}: 00EA :_i HHF
s_ fH NBA N/A
PWS:
ORW: yes I no PNA
yes / hogs
Type of Project/ Activity
F. �a
or AptAicafit Ps`inted Namp n
",tread
Dgas�-
Application Fee(s)
statement on
Phone #
Adj. Wtr. Body......tk_
Closest Mai, Wtr, Body
ZIP_.... {3.
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Basin
Permit Officer s JPlint c N r ra
Signature
Issuing Date --Expfration Date V