84647C - Shelton, George

❑CAMA M'DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification , ❑Complete Reissue ❑Partial Reissue
NO 84647 A B c D
Previous permit
Date previous permit issued :2
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:
I SA NCAC i./7 t 1 6H� ❑ Rules attached. `y General Permit Rules available at the following link: www.d . ov CAMArules
Applicant Name r)"o-Im P Authorized Agent
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Address I !'Yr �: Iij (_�/1 ,fE t ii (r Project Location (County)
City State ZIP t1 Street Address/State Road/Lot #(s)
Phone # (
Email Subdivision IV
City IP
Affected ❑ CW EW ❑ PTA ES ❑ PTS Adj. Wtc Body �-. ))"� (n'" man/unk)
AEC(s): ❑OEA ❑IHA ❑UW NSPIMA ❑PWS Closest Mal. Wtr. Body
ORW: yes/�no) PNA: yes/no
Type of Project/ Activity
Shoreline Len h _•.l L
Access Length
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A building permit/zoning permit may be required by: ) . el; Permit Conditions V � ; �
TAWPAM+_/NE--
SIEJBUFFER(circle one)
t/ � .--
y:.:.
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS ThIAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) J
Agent crA a 4,
g pp�icant PRINTED Na)ne Permit Officer's PRINTED Name
� �,cjau0.
Sig t—*"Plyear5�Bead cLlnpliance statement on back of permit"• ,, Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date