Ver _COMPLETE FILE_19860529 (2)

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~ICATION
Faa

PERMIT TO EXCA V A Tl ANOIOll FILL
EASlMEHT IN LANDS COVERED IY WAna

WATta ouA4JTY aRTlflCATION

CAMA PERMIT FOR MAfOA DlVlLOfIMIHT

011 m- ...eI 44............
(GS ''''' 21

SIIIa of NoM CMlIIIM
0...........01 NalUlll ___.... c........" 0_1..........
(GS 11)'22t. 14)0215.3(11"'. 14),215.3(,.. 113"'.111

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(33 en 2Ot.320.12'1

..... type 01 print ,nd fHl in .1 blank&. If informal" II ftOC _lcMW. 10 indica.. by ~ NIA in tit..

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po o. 8o-rt.t~ b 7 First
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/ (.,IV ~r Town
t/'IL LAcalioft of Pro~ Pro.ect;
A. County () O()^ IA I\AJ ~ }../ Jl fi _ .
.. 1. City. lown, c;ommunicy or ',ndm..r. ~ A~^,,^
2. Is prOQOMd work WIUun "Cy limtl\? Ves _ No ~
Co er.... rlvcr. ~nd or b,y U~ '~B~"t n,mcd body of w.cer 10 project

~ Detcri,cion 01 Pro;cct . / ~ --r J" II
A. 1. ~inteft'nc. of UISIl"1 pro/eet 2.~wotlt. lA'lJvt-i/Iv "It -<fVVI
I. Puroow of ,v.lIon Of /i11
,I. Accessc"'" le"ll" wldch d~lh
2. Boa. b"in len,tn w.dl" d~t"
3. Fill "., ""IUt widlh d~th
4. Other le",Ih wldcn decnh
Co 1. Bullch.~ Imllh AVeI'IIe dist,nce w,terwl,d 0' MHW (~Mfellnel
2. Type of bulkheold '0 mu,uon (muetllll 8 H LV
D. Ea"nled mateflal(toUI for oro/eeel
1. Cub" y..rds 2. Type 01 mll'!r.,,1
@Fill m.ale"..llo br:OI.Ud beiP~Mb!WAee ..1\0 VI Al
1. Cubi' y.ard, S(!Q ~ 2. Type of m.atl.'r'41

IV. LInd Type, Dispowl Arel. "nd CO"SlrUceion EQUIpment
A. Ooe\ Ihe ~1C:.a III be exC""4ted '"Colude ~"y rn4nnl"nd. \....amp\ or olher well..nd' Yn _ No ~
I. Ooe\ Ihe d,spn~1 4rc.a Include .ny fTl4"nl..nd. \...~mp\ "r olher ...eftlnd' Y IS _ No h... ----
C. OiSOQY ru
1. t.OCI' on
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O. Fill m"le".1 \I,uIl.e " 1,11,\ leJ be Ifll,kCd In
~411:f1..1 be tnrr.C"ped 4nd erO\IOn ,"onlrlllll!d'

~ypc (II CQu.pm('nl hi he' u\ed
G. Will m.annl.and he trn\\ed In Uln\ClOr\.nl e ulomenf 10 pro,e" \lle' II ye\. upl.a,n
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. Middle

8. Addre"

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2.2(5-1015
G ?f?~/on
Phon.

Screet. POBox 0' Rnlllc
N.C.

Sl..le

2721S
Zip Code

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.. UIId c.:lls"fi~cJI)tI "ltde ~l VEl.Of'f.C T~A~~1 nIJ"".s..L
C:JN5E A...... TI t.. onlt~ a
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A. Do. th. ODowd orl)I"1 ;l':lIol"e l~. ol~""ent (It lill "'.ceri." hetc.. '''elfl ~"2h W4CIt? Y~_No_
L 1. Win runoff or cSl"".'" Ifttlt ~l<ICent ..alen AI. fault ot or~Ct ~1J"iIY 011 "'Mlned "w 01 Ute

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2. Tyoe 01 di .....
1 LaAllOft of . id'.M"

VlL ,,-,. 01 sftonti ......'if 11........1:

~L UII................ ~ iuue dlaes 01 "m.iout ~ltMItmeftt of Army c.,.. 01 E...-. . su.. ........ 'OIl
__.. proiect..... il llDOIicabI.: 1IJ,f1J12

IX. L.MIdt.,.... ~ind 10 COIftOfe. 1I"Iiec1: 1D ~ '

x. .. .......... CO die Clll'ftllMNd lad_ form. 11M ,......~ I..... ....... be lIMo.' I:
A. Aaacn I COOY 0 (widt Scala _iQUOn omvl at ,at" Ift..,UlMftI ........ ....10 IOOfIUftC
dIifN Ii. CO Ih..I ~. OR If "'icaII& II not cW..ti"l to be I'" ow.... ol WId or__COt.
~ tOTW.d . c:oo of d.... 01 odMr 1naruIMR& UftCMr ....icft dI. 0WfWt c'aim_ tide !tN1 _ittm
permi\'ion from e ow to CIn'V out me DfOiect Oft his I.ftd.

AUadl VI K,urat~ 'WOf'k olit drawn to telle on 8~ X It.. ....... plOef' I ~ in"ru'bon hooillet lor
details). Not.: Orllin.' aU.I"I' prelerr~ . on'y II.~ Qu.Jitv cOOln 4cceOted.

_~ ~v ot the ~o"utJo" .nd O'IC ",U\I be wrved UDaft idiKtIfIt 'Io.n.. loIftdowftCl's by le""lred oX
certifted ",~i1 or bv ""ch'~lInn (G.S. It), 229 (dllE.llle, eLl" """ed

~ftlmes....<I ,omelet. ~d'e\'" ot lh. nO.llft I~ndowllln wun "'ODWCV actio"".. ICIOhCltlt".
5udl ~ lI..ve 30 d4\1\ If' ...tlleh 10 \Uomlt COft'_t\ IU .lftnc:Jft liued beNIw.

Ex iWtl\t

Ptaftft.

COMMUNITY RUaAL
_ (S.e CAM A l.oc.aJ und U.. ..,. Syft04ttil)

t "DeIt1;..'N M I[f

XL ClrUlic:aao.. reQuire_t: I certlly thlt to l.~ ~t of my know'edca. tit. prooolotd .ActivIIV camplla
wictJ me Scate ot North uroh".~ ..,,,,oved COIsnl ",al\l...,."t or~~m alld will be conducted .n I
_ COMiste"l with weh oro."m.

XIL A,.,., 1M'"'" "sued our,.,."t lO Ihis iOohc.uiMl _ill al!ow Of'l'y the dev.'oDmeftt a..uibed In UtK .ppli
caUon.nd 01'1. Aoofic.l"'s sllould therefore a~ti!s. in the iaOhutlOft ,nd pili .11 ,ftl"lp~l.d al'l'"
QOIIIIftC Ktivifla. indud;ft. COf'l\tNc:ion. uUlIlItion, fillinL ,nd land cl..inl.

DATI ~ c9C?, 8~

06'012

-- ...~

SEt aEVERSl SIDf. FOIt M.ALJ!'tG I-'STRUCT10NS

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PLEASE BE SURE THAi:

- BodI CODMs are ~..
- .411 ,laNeS... tm.d III
- y,., .... ..... badI GaP'-

If ~ou b~ any qunc'ons pl.- C111 yeut rqf.... fleW .....

M~I aDS CClVf co;

Disuicz En.ineer
WilminllOn Oiscrict Corp, of Enlineen
ft. O. Sex 1890
WilminllO". N. Co 28<t02
(Nate: ;tUo:h Corps tr;nsmitul ietterl
Phone: [phone]

AND

Mail 2!!.! COCtY to your relia".. field office d '"dic~ted on cne rn. beloVII;

From '*"*' .we 0' ~Ica ..... .. SlIM -.:
W lstlinlton ReliONl Offtce
Oeo.anmenf 0' NaD.ln' It..... ... ConnuIJev th JI III
1502 Nantl Martee Scr.c
Wlit'unlton. N. Co 27_
Phon_ 9'9/9~1

Fer 'eMet. NeVIl H.ltOvet' .nd a'''"swlC:k C.ountin'
Wilminlton Rellon.. Office
~utment of NUll". Re~I't:.., 'I'd Co"'",unuv D~'~loO"'~"t

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