51101_BETTS, THOMAS & WARNELL, TONY_20080521

[LAMA / ❑ DREDGE & FILL TC;
GEN PERT Previous permit #
❑New edification Cplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources '�f % J
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC rt ./`"j" Y 1 ..)�
' "; �E s attached.
Applicant Name f { Project Location: County" R .,i`
Address �` yy Street Address/ State Road/ Lot #(s)
City �- State! ZIP,
Phone # ax (_) Subdivision j
`�� (-� ZIP
Authorized Agent City __
Affected lli� A ❑ ES Ts Phone # () River Basin j
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body l fat /. an /unkn)
❑ PWS: ❑FC:
ORW: yes // j PNA yes / Crit.Hab. yes / no Closest Maj. Wtr. Body �7 —
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Signature ** Plex9114 read co lance statement on back of permit*
A'plication Fee(s) eck