93075C - Marion, Kailey

/''"u4 ',4CAMA I DREDGE & FILL
t Nc� 4:i075 A OD
111)
GENERAL PERMIT Prmnouspermit $$955
Date previous permit issued OH )� Z*5 _
fl Ncv I I ModliKanon }d'Complete Reissue J Partial Reissue
As ar.trnoruad by Mc of North
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[ I W.ras wrtTried ix(a.„...ft.,.,t kart reelable at the
f0b""/'ti Ir1, wwrtclo4nc vr.1'CAMN YkS
ApsTe•rd Nan a ,.1
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Addrr77 121. _Ap1h C�'Itiia /v1
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P �tari.cx c,k'c„yLAA1l .Stage.•MI, !1P 23.524
Sir eel Addrestdule Noadd.Of a(. bow. L Vvt e.414. Dr'
Phnc g(33 4 el~ '5-51
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Car_Emerald-Isle_ ,le Z9`i _
Mee red kr:INL 1� f1)jut PTA Lies L_i PIS A.* Wit I4.11 - i co/ _la L
OmaNunkj
I IMA UW iiSPMAA nMS Cimmt Mal WI, Body (/\,�
OqW ,w PNA.red _
Type of Project/Activity.1)Yr Y-•fp` .d ri pet 1(1(,..�•�h,,,,_ y,,.._(k 1 t11 -
Shoreline Length "`t �''.`_ =,cu L 1�.Y1 1 T [ — (Scale: )
Attest length_le'r. �_
NI(Amos)length ' 'Q I 1
IiardPtadurrrrlsl 10.S 1
—
/hinting Plathrotwe►1 - C /� / /�{��}/,r jo
1 rsger Puerto) (S f S V l l.,'`O r •IV s'e/T l�
TOW Rather,area 2 r`-1`-�� V`-T: l!1 C1\t\ 809 S—v C.
Groin length/1
&Ahead/Btprap length .� ___ Ai(
/p l �1 /
Avg di7tence adth,xr '' �\ V T l V(cAs c O NDi i t Vs
BMA""weer/S,H ' •
El
resign IMIlaidat4
n v
,rh ,nel_ 1Wf1
yards '"' _ �� 11 i ��
Hoot ramp
Bnaltqu ,Bain ' -11---.
M•.-h B,Aldottng _ _ - _
Orhr•_Ly1)e1 I' Orit��►1
SAY„h.nved Yeti
Moratoewrn: n/a t
Site viola. Yes
R,patisn%Uwe(*niched rs ro •T, 1
A Amai !pem,tlroemg Omit Hutt be rMji,ed by &WA'N i T k L r-aa..�..c4 .^Qwi�/
vane l nndnrnH+s I —_ f.Ltrai�=-.��S�F�Q��1. r`' f�TA�tf'AINNEJSCIBUFFER(cycle one)
rJ
-- I ii Sc.Hole us tine,Y regarding River Aas+n rules
•
-- U Ste addlrhr,al no1K/cnnr4inrons on bar i,
I AM AWARR Of STATUTES CRC RULES AHO COhpr10NS THAT APPLY TO THIS PROLE(/AND REVN WED COIAPLtANCF stay MENT.
`Y (Plaasr,Initial' >�j/�',
_Tgrut or --.- ----- _lY'T.1 fc t Ag Pi►r+p INIE r Pons t fleet'.PRINT
rn
S s,re 'Pilate ,cnrTI4,iente statement pet deck of permit..
—
it)
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AtgtttaTlt:n Fs ys) _ dip /s Ic ---
/Mort Order tssuing Nee
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1

��`°"'"� NCAMA [ I DREDGE & FILL N9 93075 A B UD
3°
GENERAL PERMIT iPrevious permit $9ssG
`' Date previous permit issued 04 1` )25
n New Modification ®'Complete Reissue El Partial Reissue
As authorized by the State off North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 0-3►1. 11-00 Rules attached. N General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Namea �1 1 I \ A\Q� Oil Authorized Agent 1�
Address 'JZOS ! J ' AnkI l c�` • Project Location(County): Cotri-CX•cik-
f tj �7 #(s) 3002. EVY1 era let lD r.
City N A�J,YI1'1GState C. ZIP L�SZ StreetAddress/StateRoad/Lot
Phone#(l33J(D) 1_81 5 -S61'I
Email Kai IfiNII ( v.%on ci/vtiAl I.prn Subdivision ,
City E-y,eral4 Jslc ZIP 2 - 1 11-
Affected XICW KEW PTA ❑ES ❑PTS Adj.Wtr.Body Boo tAe sg/WA CA et man/unk)
AEC(s): n OEA n IHA UW SPIMA PWS Closest Maj.Wtr.Body 16y`'y„A'�`-�
ORW y no PNA:ye/no V
Type of Project/Activity f 9)1 p;er. v W K-Die'v be l
(Scale: )
Shoreline Length 3
2n1 i ' a 1 I 1 i
Access Length (D r` v 7 i 1 --
I
Pier(dock)length (.O•x 1� l'/,1 ;
Fixed Platform(s) l!o/X 1(Q•S 1 )............. ........_ �� 4
_.. __,
t F . —r- ' -
Floating Platform(s) r".. --k l Th I ( � O\ ��1 ►'u �(�
.
Finger pier(s)
ss (ke of eR 9 09 S-- --C,. '
Total Platform area L`�P s{-� v,
Groin length/# — ! { . { i'^i r$ I I
Bulkhead/Riprap length ; — ... {
� - \ Y VV(l-(/�S CO' i (t°V U 3
Avg distance offshore i
Breakwater/Sill ��,,,,,� j 1 I I I ! ` I i
Max distanceASP 1 L q '�(Dr,,k 4 k-head l
. 9_, �� _ L
Basin,channel
Cubic yards
Boat ramp • i
Boathous Boatl'• U2 1<j o ;
Beach Bulldozing i (...._...
Other Q411 I SHIP alit-thong-ad I 1 I .
SAV observed: yes •. j- - .
Moratorium: n/a yes I i ,�
Site Photos: yes -- --- . !_. _ ! -_.__T.-_�.__
r
Riparian Waiver Attached: es no C � I _..1 _ ._
A building permit/zoning permit may be required by: LI'VIU'A(d Ts(-e I C/ay e Co(itt4
n TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
nSee note on back regarding River Basin rules
nSee 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)
Agent or Applicant PRINTED Name Permit fficer's PRINT Nam ,
127-14
Si ature**Please read compliance statement on back of permit** Signature
Zoo s 2 1;0 5--/L3 0 z/21Zy
Application Fee(s) drip/Money Order Issuing Date Expiry on D to

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax:[phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

doc"srk. OCAMA DREDGE & FILL No 93075 A B OD
P3 Previous permit r=r —7 G
3 i GENERAL PERMIT
Date previous permit issued O`I I i 4 J 2
n New n Modification []Complete Reissue n 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:
I 5A NCAC O I P P. 11OD Rules attached. [ General Permit Rules available at the following link:www.deq,nc.gov/CAMArules
Applicant Name /‘Ci11 AeyI M(3V 1 CV) Authorized Agent
Address 2 U5 /.J M0k in Si-• Project Location(County): r_ i t'
City oct,A Vaw iv t&(State N C. ZIP 2 4 S 2 I Street Address/State Road/Lot#(s) 3nr)2 E yvl e.rA 1,4 Dr•
Phone#(1i31p) fi 1'5 .SS
Email KA I'.e.I1 f,.,'\ mew.i or\ ai l ilt\ cowl Subdivision
J city Fwleralei -' s►c ZIP 2/ 9 Li
Affected RICW tktEW A 0 ES n PTS Adj.Wtr.Body g)(- .LAP Co(i1y"A i'man/unk)
J
AEC(s): 0 OEA n IHA UW ❑SPIMA n PWS Closest Maj.Wtr.Body YJL,LD ¶.4 A(I
ORW:yes no PNA:ye no
Type of Project/Activity PYOrErd 0 e r, V`6mI\(YTH t-f+
(Scale: )
E *'ic' i
oreline Length
I
I w_• - i _ Tht
! 1 I I_ Imo_ _ _
- 4 _! l- 6 r � 1
Floating Platform(s) �.
Finger pier(s) ,ram _
Total Platform area s`ecei- r t
Groin length/# •i
Bulkhead/Riprap length / `
Avg distance offshore �� _- t •. , , Y '� !I_;i i 1 i �', 1
MaxBr
waance III k)rt1N # _Mx distance en ' � �
Basin,channel l 1 ti ' ` '
Cubic yards
Boat ramp
Boathous: . 17 ' ><) I I
Beach Bull.ozing / f
j _. - 6 ...,- j..
Other 11
O>1j.i ( 5(% (.l�,theNo ,
SAV observed: yes no '-
Moratorium: n/a yes no ' i. `_`..._w_"»_- `^•". 4
Site Photos: yes no I _ ; i_ ) ...... i
f -}
Riparian Waiver Attached: Lam' no i i- !
A building permit/zoning permit may be required by: !- ,- V 1 _i 5 it (;t'r —cre+ Co EA
Permit Conditions I � I piTAR/PAM/NEUSE/BUFFER(circle one)
riSee 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)
'Agent or Applicant PRINTED Name Permit Officer's Name ,
`
Signature**Please read compliance statement on back of permit** Signature
LOD
Ap lication Fee(s) Check#/Money Order Issuing Date Expiration D 1 te

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden,Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

1o'`°"r"i. CAMA I I DREDGE & FILL No 93075 ABC D
si ! GENERAL PERMIT Previous permit
3 Date previous permit issued
n New n Modification n Complete Reissue n 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:
15A NCAC (---.I 1i' ( J'" -) n Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name 411 (AI 'A\ iV V1 C Authorized Agent
Address 1 LC i. ' 1 C t\1,1 Si--• Project Location(County): C.'1(-i-f'r c
City 1,--ic(CI'+ Vex Y't11((State k) C. ZIP 23'52 i Street Address/State Road/Lot#(s) 'CC'L LN I C Ya4I ei Dr"
Phone#( ; lll) 1'1a • 'r .J1
Email k/�,I(,IhiI t` ( 1'tr‘l (4 r\mak`.CCIN) Subdivision
1 City 'iv-t y('tt 9I`i " It- ZIP ?i Ci 44
Affected n cw MEW PTA n ES n PTS Adj.Wtr.Body ' J L(E' .,` C. (n, man/unk)
AEC(s): ❑DEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body f I(,4 CD.(Ad
i
ORW:yes/no PNA:yes/no Type of Project/Activity PYn '`-fr't :s e r, V(ft K-iN I\ ).\P(r'r4 t c
1 (Scale: )
Shoreline Length _- ,
Access Length '..e xhk-' -} i ! -
Pier(dock)length (.! 4 I C`1 _
Fixed Platforms i
'' Xi&_ t } _ 1 _ .
Floating Platform(s)
* -.1111 c. I A licrit?Cc4-e. .
Finger pier(s) .------ i
4" ' C I: (I1-- (2' CT-7-
Total Platform area . ;iLl-f- i } I
Groin length/#
Bulkhead/Riprap length ...-_-- .. __.__..........
Avg distance offshore "'' + } ! ( '[ v( A 6 r- `��( v
Breakwater/Sill -'` I 1
Max distance/len 14"I ^Yc i"LA1t 4 o� I
Basin,channel ' j -- _} �`_' 1f 'C'"k t1
� -- I
Cubic yards "—
Boat ramp I i l
i } ,
Boathouse/Boatlift t..- 41 1)r ! f [ 3
Beach Bulldozing J
Other ' ,�0/. 1
•
SAV observed: yes no I'' - 9 " -- _�....____� __—
Moratorium: n/a yes no : " I i t
Site Photos: yes no. — — _—_ -- .-€ .. . —
Riparian Waiver Attached: yes no I _ Y f
A building permit/zoning permit may be required by: E'\iC rA TS It I ,. ,G\Y-t }f rk Co(.lkt{'ki
Permit Conditions n TAR/PAM/NEUSE/BUFFER(circle one)
❑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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit** Signature
t Application Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

Guthrie, Kara L
From: Chad Marion <[e-mail]>
Sent: Thursday, October 19, 2023 9:55 AM
To: Guthrie, Kara L
Subject: [External] 3002 Emerald Isle dr
Attachments: Cama permit 4_14_23.png
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hey Kara hope your doing well
We have a cama permit we already have the cape carteret permit pulled. However was looking my Marine Contractor
took a little longer than expected to get us on schedule and I noticed the
Cama permit had expired. Everything is staying the same just need a continuation or new cama permit issue.Trying to
figure out the best way and easiest way to do it with out having to make a trip down there I live in Raleigh please let me
know what you think?
Thanks again
Attached below is the cama permit

Chad Marion
Rooter&Sons Plumbing
2474 Walnut st#227
Cary, NC 27511
9199802166
3

".'" ' CAMA I I DREDGE & FILL N() 88955
1 A BCD
GENERAL PERMIT Previous permit ...---'
Date previous permit issued �''
4 New []Modification Li Complete Reissue Li Partial Reissue
As authorized by the St
State of North Carolina.Department of Environmental Quality and the Coastal Resources Commission man area of environmental concern pursuant to
ISA NCAC 0�a4• (Z oo _._ U Rules attached General Permit Rules available at the following link:wyjeot r c.g v/CA►Wules
Applicant Name K.Ai Its. AY j on Authorized Agent_- / 17!
Address 32cs N_LI_ain _ St. Protect Location(County) C.cly4-exC _
Cityf 1AC 4tM Y`IArin41 State NI G ZIP 21521 Street AddressiState Road/Lot N(s)30 02. E)^r1Lro(d DtrkS1e
Phone 0(ale) sis- GS51
Email_kOkikit rllw►arlaVi ® gh/IPI;I.,c.o Sutxlwrsron „....--
city Ec nereAld Is.W [)(! Ies, y
- ZIP 2.859
Affected NICEW XPTA DES OPTS Ad {! c
t Wir Body _
e, �JV Ci na nardunk)
AEC(s) [ )OEA LIMA BMA I I UW 17]SNMA RPM Closest Mal Wu.Body O tie SaA►\d
OR ,/1,in PNA sr
Type of Project/Activity. C rc leo)e d_.?I ear , p I ck I Q V►VI l_ oats 1
(Scale:NTS )
Shoreline length 3 I .
y I . L, AA"
f�J1
Access length V/ X"�/ I I 1Z:X1 V'�l / IS' �1�1cr'ti' ° lV` / I
Pier(dock)length �O X I V� 1 • I /^ 1 Pr
Fixed Platform(s).1�x1 L.5.' I O ,�1l,1' M
T 04(
YOyy c—j�lUl`�'
Floating Platforms) I 5u',,t 1 I J"
— r"u wol
Finger piers) ..../_- -_- -- - I I
Total Platform area Z D'{ YV1N( I
Groin length/If_ - Cd 109 I
Bulkhead/Riprap length I
`�
Avg distance offshore / g',1.0C,Y s.t��Breakwater/Sill — I I
Max distance/ ' ' I ors11p.A1{�.vwN I '• `Basin.channel I e cklt o- CV3
Cubic yards / '�— /�� I J' T
`l.
Boat ramp r f `—� �/ 1 ,1, v� �y/ - 1
Boathouse/Boallift 12 X( I 1. W Crnq
Beach Bulldozing /. _. 1 v Vi .NfrI. . I Al
Other DN ky 1 S+p_ b X a!/ w. N{- V�'
QCW y ``' �� / , 1 a 0vs V �1/ o c St!x—f N L
I SAV observed Ye's (v,lA1VPk) ( 1
Moratorium. n/a yes J ` t.� C
SrtePhotos yes pewits.;Liz SI Ek1S�he( b(/11 /�OI S See JrsAGl)
Riparian Waiver Attached es nn iejtl„Q1J AY1On ! I �,�,C 1't�1�� rJ
A building permit/toning permit may be required by _ E Y1XXQ1 t O :I c tee Y"�t
Permit Conditions /�T(`*alI S & 1WL{2Czf .. Zyt serf-4
JON4 0� 8 TAR/PAM/NEUSE/BUffER(circle one)
AI IO(-1 d• 1-1n� 9n DVw'! I V`i�tE/`t WW SI'1dl I)-.)
See note on back regarding River Basin rules
elcvo►icd cM cats+ 3 f+ above C 10 sobs iv e_•_
ElSee 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)__- KM 1
ar' on _Kara. Efittliri_e_
Agent or � j D Nam
Per i Officer's PR NTED Na ,
-
Si r ature"Please /ad compliance statement on back of permit•• Sigma
Application Fee(s) /ChecleV/Money Order Issuing Date Expiration I ate