Blue Treasure, LLC 76353C

As auth
and the
Applicant
,MA / ❑ DREDGE & FILL No. 76353
A B C D
NERAL PERMIT Previous permit#
o ❑Modification ❑Complete Reissue El Partial Reissue Dateyrrevio s permit issued
by the State of North Carolina, Department of Environmental Quality � I, —
d Re so rce Commission in rea of environmental concern rsuant to I SA NCAC / /
ales attached.
neA k A 0 W I., Project Location: County
Street Add f sss/ State Roa / Lot #
State AI(ZIP ;?"Q
Phone #
Authorized Agent
Affected *W
AEC(s): ❑OEA
❑ PWS
ORW: yes /I
Nw TA ❑ ES ❑ PTS
❑HHF ❑ ❑UBA ❑N/A
PNA Qs)/ no
Type of Project/ Activity
Phone # ")
Adj. Wtr. Body_
Closest Maj. Wtr.
River
ZIP
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ism
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A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ SpecipLl Conditions
or
•*- PleMe read
❑ See note on back regarding Ri r Basin rules.
Fee(s)
Check #
Date