HomeMy WebLinkAbout59361_BRADY, WALTER_20111108��(�'f - : • 1
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GENERAL PERMIT Previous permit #
ONew ❑Modification ❑C:omplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City_ -- — — -- State ---ZIP ,.-f' • J ` i 1 /I
Phone # () _ Fax # (— _) Subdivision
Authorized Agent _ _ _ City ZIP
Affected ❑ CW EW 'PTA ES PTS Phone # O River Basin
AEC(s): �OEA HHF IH UBA N/A Adj. Wtr. Body (nat /man /unkn}
PWS FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body —
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Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Issuing Date
ApplicationFee(s) Check# Local PlanningJurisdiction
Expiration Date
Rover File Name
h
Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific 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 or certified mail return receipt has been obtained from the adjacent riparian
landowner(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 ❑ Other:
❑ 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
' rtypllC�nt.+w
L?)jN� k j� lets: h1O OC
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Describe below the HABITAT disturbances for the application. All values should aiatch the name, and units of measurement
found in your Habitat code sheet.
Habitat Marne
TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
inch' '= a-
anticipated
restoration or
tem impacts
FINAL Sq, Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im a t'al;nqupA
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL F7final
(AnticipatDISTURB
disturban
Excludes any
restoration and/or
temp impact
amount
t&
Dredge ❑ Fill ❑ Both ❑ Other
/ q'VY
C
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge Cl . Fill ❑ Both Cl Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
u-12•t:v!3-.�,'3G ,. �..:;;;y:;-'2>wfJA::>7 ,. �,r..;v'�.n�r_-,.��;:acr,eia..._, ...�,iyr..r..at .........,..t. �^.��'C;•t; �,�
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL iiilANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: WALTER D. BRADY C/O CROATAN INVESTMENTS CO,, LLC
Address of Property:
LOT 3, BLOCK 99-.SHEPARD ST, MOREHEAD CITY, CARTERET COUNTY
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 252-241-2780
Mailing Address: 805 FRONT STREET
BEAUFORT NC 28516
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
X I have no objections to this proposal. I have objections to this proposal.
tf you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalrnangementneticontact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to
waive the setback, you must initial the appropriate blank below
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
WALTER D. BRADY
Print or Type Name
805 FRONT STREET
Mailing Address
BEAUFORT NC 28516
City/State/Zip
252-241-2780
Telephone Number
Date
(Riparian Property Owner Information)
llel'<
11�-
Signature
WALTER D. BRADY
Print or Type Name
805 FRONT STREET
Mailing Address
BEAUFORT NC 28516
CitylStatelZip
252-241-2780
Telephone Number
/G - ZC l/
Date
I
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: WALTER D. BRADY C/O CROATAN INVESTMENTS CO.; LLC
Address of Property:
LOT 4, BLOCK 99, SHEPARD ST, MOREHEAD CITY, CARTERET COUNTY
(Lot or Street #, Street or Road, City & County)
Applicant phone #. 252-241--2780
Mailing Address: 805 FRONT STREET
BEAUFORT NC 28516
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
X 1 have no objections to this proposal. I have objections to this proposal_
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www,nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to
waive the setback, you must initial the appropriate blank below.)
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
WALTER D. BRADY
Print or Type Name
805 FRONT STREET
Mailing Address
BEAUFORT NC 28516
City/State/Zip
252-241-2780
Telephone Number
Date
(Riparian Property Owner Information)
Signature
WALTER D. BRADY
Print or Type Name
805 FRONT STREET
Mailing Address
BEAUFORT NC 28516
Crty/State/Zip
252-241-2780
Telephone Number
2c it
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2. Article lQ =ber
PS Form 3819, February 2004 Do^neSfic R,tufr. Rece,�rzut -�•f�a
r
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: WALTER D. BRADY C/O CROATAN INVESTMENTS CO., LLC
Address of Property:
LOT 3, BLOCK 99, SHEPARD ST, MOREHEAD CITY, CARTERET COUNTY
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 252-241-2780
Mailing Address: 805 FRONT STREET
BEAUFORT NC 28516
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
X I have no objections to this proposal. I have objections to this proposal.
- If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.nebcontact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setback, you must initial the appropriate blank below.)
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
RECEIVED
(Property Owner Information)
(Riparian Prope Owner Informq#gn)j 4 2011
/%�
Signature
Signature DCM-MHD CITY
WALTER D. BRADY
WALTER D. BRADY
..Print or Type Name
Print or Type Name
805 FRONT STREET
805 FRONT STREET
Mailing Address
Mailing Address
BEAUFORT NC 28516
BEAUFORT NC 28516
City/State/Zip
City/State/Zip
252-241-2780
252-241-2780
Telephone Number
Telephone Number
A, "l� -7cV
/�;` /z - ZGl/
Date
Date
North ; arolina secretary of State
46
http://www.secretary. state.nc.us/corporations/Corp.aspx?Pitemld=77...
North Carolina
ti
Elaine F. Marshall DEPARTMENTOF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NC 27626-0622 (919)807-2000
Date: 10/14/2011
Click here to:
View Document Filings I Sign Up for E-Notifications I
mJ Pre -populated Annual Report Fillable PDF Form I File an Annual Report
Corporation Names
Name Name Type
NC CROATAN LEGAL
INVESTMENTS CO., LLC
Limited Liability Company Information
SOSID:
0776658
Status:
Current -Active
Effective Date:
4/12/2005
Dissolution Date:
Annual Report Due
Date:
Citizenship:
DOMESTIC
State of Inc.:
NC
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
JONES, LEONARD
Office Address:
300 NORTH 35TH STREET
MOREHEAD CITY NC 28557
Mailing Address: 300 NORTH 35TH STREET
MOREHEAD CITY NC 28557
Principal Office
Office Address: 805 FRONT STREET
BEAUFORT NC 28516
Mailing Address: PO BOX 3576
MOREHEAD CITY NC 28557
Officers
Title: MANAGER
Name: WALTER D. BRADY
Business Address: 805 FRONT STREET
BEAUFORT NC 28516
RECEIVED
OCT 14 2011
DCM-MHD CITY
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version:
1213
1 of 1 10/ 14/2011 14:14
.•STROUD ENGINEERING, P.A.
Hestron Plaza Two
151-A Hvvy. 24
MOREHEAD CITY, NC 28557
(252) 247-77479
TO CA/ -I / `
DATE Q ` 1 JOB No. PO—
� 0 70
— �7
ATTENTION ! l' !/
RE:
tat
WE ARE SENDING YOU 9 Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints L Plans ❑ Samples ❑ Specifications
17 Copy of letter ❑ Change order ❑
COPIESDATE
�o-3-lr
NO.
DESCRIPTION
Lat 3 X"
THESE ARE TRANSMITTED as checked below:
VFor approval ❑ Approved as submitted
* For your use Ei Approved as noted
❑ As requested I Returned for corrections
i� For review and comment L_
Ci FORBIDS DUE
REMARKS
'. Resubmit copies for approval
-i Submit copies for distribution
1-' Return corrected prints
PRINTS RETURNED AFTER LOAN TO US
T 14 2011
CITY
COPY TO
SIGNED.�'v�'
If enclosures are not as noted, kindly notify us at once.
IL_
f
STROUD ENGINEERING, P.A.
CONSULTING ENGINEERS
HESTRON PLAZA TWO
151-A HWY. 24
MOREHEAD CITY, NORTH CAROLINA 28557
(252) 247-7479
October 14, 2011
Randy Martin
Town Manager
706 Arendell St.
Morehead City, NC 28557
Phillip A. Lewis
PO BOX 622
Greenville, NC 27835
RE. Lot 3 Block 99, Shepard Street, Morehead City, NC
Adjacent Riparian Owners,
Enclosed you will find a copy of the submittal package for a General CAMA Application
for the above referenced project. The proposed project is to construct two boatlifts, a gazebo, and a
dock as shown in the attached plans. As adjacent riparian landowners you have 10 days upon
receipt of this notice to submit comments of the proposed project to the Morehead City DCM
office
Please send any comments to:
Heather Styron
400 Commerce Ave.
Morehead City, NC 28557
(252)808-2808
RECEIVED
OCT 14-'
( DCM-NIHD C°T�'
t
Sincerely,
David W. Gambardella
107 COMMERCE ST. HESTRON PLAZA TWO
SUITE B 102-D CINEMA DRIVE 151-A HWY. 24
GREENVILLE, NC 27858 WILMINGTON, NC 28403 MOREHEAD CITY, NC 28557
(252) 756-9352 (910) 815-0775 (252) 247-7479
f
CARTERET COUNTY
21798 04/15/2005
$1,500.00
oT"TEA`Tf{ ..= Real Estate
f OLiNA t ' Excise Tax
n
Melanie Arthur 4P
CARTERET COUNTY
JL Date 04/15/2005 Time 13:49:00
OR 1106329 Page 1 of 4 .
NORTH CAROLINA, (,ARTt"A}: f t', LINTY
The foregoing cerlifice:tF{s?
Certified to be correct. Titt;r irts;:.:n?rsrt . ncs tTi tiu:litk
ivtetec'
r .:.i Q:i; �S•'� '-"nl: i'ili'y itl'Icl Irt
cats are duly oQ �
the gook and Page shv,'W,By
- Ass w( of 17w:tt
n—VtVing Ut
WARRANTY DEED
Prepared By: Samuel A. McConkey, Jr., Attorney at Law
STATE OF NORTH CAROLINA
COUNTY OF CARTERET
Documentary Stamps: $1, 500.00
Parcel #6386.19.60.0677000
THIS WARRANTY DEED made and entered into this 4tli day of April, 2005, by and
between:
C
THOMAS S. BENNETT and wife, VIRGINIA T. BENNETT
and
SAMUEL A. McCONKEY and wife, KIMBERLY B. McCONKEY
of
Carteret County, North Carolina
(hereinafter "GRANTOR") RECEIVED
and
OCT 14 2011
CROATAN INVESTMENTS CO.., LLC
whose address is: , DCM-MHD CITY
300 North 35th Street
Morehead Cif, NC 28557
(hereinafter "GRANTEE")
The designation GRANTOR and GRANTEE as used herein shall include said parties, their
heirs, successors and assigns and shall include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSETH:
That the GRANTOR, for a valuable consideration paid by the GRANTEE, the receipt of
which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto
1-ROO10� G, 5oO - ►�
the GRANTEE in fee simple, all that certain lot, tract or parcel of land situated in the Town of
Morehead City, Morehead Township, Carteret County, North Carolina and more particularly
described as follows:
See Exhibit A attached hereto and incorporated herein by reference.
The above described property is conveyed and accepted subject to such easements,
restrictions and rights of way as appear of record in the Carteret County Registry.
TO HAVE AND TO HOLD the aforesaid lot, tract or parcel of land and all privileges and
appurtenances thereto belonging to the GRANTEE in fee simple.
And the GRANTOR covenants with the GRANTEE, that GRANTOR is seized of the premises
in fee simple, has the right to convey the same in fee simple, that title is marketable and free and
clear of all encumbrances, and that GRANTOR will warrant and defend the title against the lawful
claims of all persons whomsoever excluding the exceptions stated herein and designated on the map
referred to above.
IN WITNESS WHEREOF, the GRANTOR has hereunto set its hand and seal, the day and
year first above written.
id'.
(SEAL)
Thomas S. Bennett, Grantor
V{� ✓, EAL)
Virgins T. Bennett, Grantor
SEAL)
Samuel A. McConkey, ran
�� 6 AC—!�O(SEAL)
�Ep Kimberly B. McConkey, Grantor
oC� 14 Zg11
DAM-MxD 0'f"
f
STATE OF NORTH CAROLINA
COUNTY OF CARTERET
I, a Notary Public of the county and state aforesaid, do hereby certify that Thomas S. Bennett
and wife, Virginia T. Bennett personally came before me this day and acknowledged the execution
of the foregoing instrument.
,uuumuupn,r,
Issyr� ''tand and official stamp or seal, this L� day of April, 2005.
; .0TARy.
i COMM. EXPIRES
20090921 = Notary Public
Myobslies:O9-2�- 2O04
er c 0���
STATE 0 V"CAROLINA
COUNTY OF CARTERET
I, a Notary Public of the county and state aforesaid, do hereby certify that Samuel A.
McConkey and wife, Kimberly B. McConkey, personally came before me this day and
acknowledged the execution of the foregoing instrument.
,�pp�r,IIlltlib,b�t
n ?fr hihand and official stamp or seal, this 4ti day of April, 2005.
.�01AFf
i COMM. EXPIRES `;
20090921 Notary Publ'
My`cor=lss i\ �i s: Oq-ZI Z0O`j
k RECEIVED
�Cr 14 2V
DCM MHD CITY
EXHIBIT A
Being all of Lots 12 and 13 in Square 99 as shown on the official map of the Town of
Morehead City, together with the extension of Lots 12 and 13, Square 99 in said Town of
Morehead City to the mean high water ►nark of Bogue Sound as more particularly
described below:
BEGINNING at a stake in the line of Lot 11 and Lot 12, Block 99, which stake is located
S5-45 W 39.5 feet from a point in the southern right of way line of Shepard Street, a
common corner of Lots 11 and 12; thence from said beginning point S 5-45 W 201.45
feet with the Alex M. Lewis line to an iron pipe, the southeast corner of the Alex M.
Lewis lot; thence with the mean high water mark of Bogue Sound S 38-30 E 159.1 feet to
an iron pipe; thence N 5-45 E 298.6 feet to a point; thence N 74-57-W 111.45 feet to the
point of beginning and being an extension of Lots 12 and 13 to the present mean high
water mark of Bogue Sound.
The above being all of Lots 12, 13, 3 and 4 of Square 99, in the Town of Morehead City,
fronting to Shepard Street and running to the mean high water mark of Bogue Sound,
including all riparian and littoral rights incidental thereto. For title reference see Deed of
record in Book 226, page 477; Book 130; Page 278; and Book 142, Page 499, Carteret
County Registry.
eoaK /166 PAG3E--
PSCEM"
OCi 14 2011
4 I)CM-MHD CITY
4
CROATAN INVESTMENTS CO LLC 2653
805 FRONT STREET
66-1246/531
BEAUFORT, NC 28516
Pay to the r�
Order o � d.C` _
Dollars ni
Beaufort, NC 28516
For �__ M'
1:053 L L 24[ 6D: 00 L077971t' 2653
CERTIFIED MAIL • RETURN RECEIPT REQUESTED RECEIVED
DIVISION OF COASTAL MANAGEMENT OCT 21 2011
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
13CM-MIiD CITY
Name of Property Owner: WALTER D. BRADY C/O CROATAN INVESTMENTS CO., LLC
Address of Property: LOT 3, BLOCK 99, SHEPARD ST, MOREHEAD CITY, CARTERET COUNTY
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 252-241-2780
Mailing Address:
805 FRONT STREET
BEAUFORT NC 28516
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
Zi have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information]
,Signature
WALTER D. BRADY
Print or Type Name
805 FRONT STREET
Mailing Address
BEAUFORT NC 28516
CitylStatelZip
252-241-2780
Telephone Number
Date
(Riparian Property Owner information"
f
L
Print or Type Name
`7br, 1h,., �ll
Mailing Address
CitylStatelZip
Telephone Number
Date
SITE NOTES
PROPERTY AREA
LOT 3 = 13,227.6 SF (.30 AC)
LENGTH OF SHORELINE
LOT 3 = 50.49 FT
DECK ALLOWED (8 SF PER FT SHORELINE)
LOT 3 = 403 SF
# SLIPS
LOT 3 = 2 SLIPS
WETLANDS
LOT 3 = 3.826.06 SF
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N/F PHILLIP A. LEWIS
DB. 914 PG 356
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10 Fr ALLEY
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DATED MARCH 27TH 2O09
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AEC - AREA OF ENVIRONMENTAL CONCERN
COE -CORPS OF ENGINEERS
DB -DEED BOOK
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CAMA / 0 DREDGE &{ FILL
G❑ENERAL PERMIT
IM New []Modification -(:omplete Reissue L Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commis ion in an area of environmental concern pursuant to I SA NCAC
Applicant Name
Address
City State ZIP
Phone # C-1) Fax #
Authorized Agent
❑ CW 11 EW 0 PTA ❑ ES [IPTS
Affected 0 OEA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC(s): PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
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Previous permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
Rules attached.
City ZIP -
Phone # (,) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
)
Pier (dock) length
Platform(s)
Finger
Groin
Bulk
Basin
_
Boat
Boat
Beach
Other
Shoreline
SAV:
Sand
Mora
Photos:
Waivery
A building permit may be required by:
Notes/ Special Conditions
❑ See note
on back regarding
River Basin
rules.
length
head(
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'
number_
Riprap length
avgdistance offshore
max 'stance offshore
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Agent or Applicant Printed Name PermitOfficer's Signature
Signature Please read compliance statement on back pf permit Issuing Date Expiration Date
Application Feels) `- s : Check Local Planning Jurisdiction Rover File Name
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IP A., L,Ew15 + N/f TOWN i
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