HomeMy WebLinkAbout84622C - Clemenic, Steven❑DREDGE & FILL N9 84622 A B C D
Previous a GENERAL PERMIT Date permit previous spermitissued
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State c North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
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ISA NCAC � i ,.Rules attached. General Permit Rules available at the following link:www.deq.nagov/CAMArules
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Applicant Named ill?Uo.(1 E'-{'w-,1-/j I i'. Authorized Agent
Address nm!` r7 -� t NLo 0 � 1 V �'-' Project Location (County):
City A ve-) -(y�.. state A zip Street Address/State Road/Lot#(s)
Phone#(
Email subdivision
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Affected ❑ CW -[DEW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body lf� r { (nat/man/unk)
AEC s : OEA IRA UW SPIMA PWS > r~
O ❑ ❑ ❑ ❑ ❑ Closest Maj. Wtr. Body / 1 ) i .
ORW: yes)no 7 PNA: yes/no Type of Project/Activity fin A P.21'Ee (V)
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A building permit/zoning permit may be required by L.Of 1,4t
Peit Conditions tj(< � TAWPAM/NEUSE/BUFFER (circle one)
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.)! See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
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Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date
.&a�`a CAMA El DREDGE & FILL N° 84622 A B C D
a Previous permit
GENERAL PERMIT Date previous permit issued
3
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
ISA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nagov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot#(s)
Phone # ( - -)
Email Subdivision
I
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ MA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtc Body
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ORW: yes/no PNA: yes/no i
Type of Project/ Activity
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A building permit/zoning permit maybe required by ! f V (" ' f
TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name -
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Expiration Date
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