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HomeMy WebLinkAboutAmerson, Garyb(CA►MA / C� bREDGE & FILL ". J . GENERAL PERMIT Previous permit# NNdw d'ficayin ❑Complete Reissue ❑Partial Reissue Date previous permit issuedilo As authorized by the Stale "9 na, Department of Environment and Natural Resources ! t r j 1% and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC { {: I ��._.3i� . � "I and )] Rules attached. Applicant Name r <.. Project Location: Coun?-- Address Street Address/ State Road/ Lot.#(s) j City f �� i 'State jig'"' ZIP��if Phone r;r Phone # ( `} ), /. f�Fax # (_) 1 '• Subdivision Authorized Agent �J r;. t ,, s Clty i , { i �` ZIP '� t ) - _.. "._ __. ? J Affected ❑ CW , � Ew NPTA XkS ❑ PTS Phone # (�Y�-')�y.i� ~; l River Basin ❑OEA ❑HHF ❑IH ❑UBA ❑N/A ff= AEC(s): Adj. Wtr. Body l`! j t ';(� ' "4 U j K(t,l (nat /man )unkn) ❑ PWS• ❑ FQ t �— t Closest Maj. Wtr. Body } I ` ORW: yes / no PNA yes no ) Crit.Hab. yes / no 1 , t"` Type of Project/ Activity E 11��' (Scale: Pier (dock) length 1 [ 1. tl%D ` arl l Platform(s)_ Finger pier(s)_ Groin length �nutnber _ ($Ulkhead/ Riprap length avg,distance offshore- 0 max distance offshore channel cubic yards Boat ramp ���� Boathouse�xitHff )4,1 2 Beach Bulldozing Other 7)'/1',(- Shoreline Length SAV: not sure yes no) rSandbags: not sure yes <n Moratorium: n/a yes fio3 i Photos: yes ��',n,..o' Waiver Attached. yes jno) d MEMEMMEMEMEN �.�■��■ �.�■��■■■■ pu■■■ o I rI ■■■■ ■■■W ■■■■■■0p����■■■■■ �M■`■■■CYAN ■�■■MMUMNS �� ■qi■�■■■■� 110MME`..M 1■■■■■■■■■■■■■■ .■�:■■■■■� ■■■ .... ..■. 11111 ■ ■■®■■■w■■■■r�■■■ ■■■■ OEM ■wo■i��asr■■�q�■■■■ MEMO 'ammu�■wi�i)Arm i■ a ■�I.. ■ j L LE■rMAM ■ ■■■■■■ ■ MME■■■r•►■■■■■■■!■■■■ ■� ■■■ t '''J■r■ �.■r■��iC �■C :■rl:�■Idliil� limp PR (i �► ?A ■■■r ■■■ ■■■ ■■■■■■�■■■ js■ NEON NEW moms■■■■■■■■■■■■I®■�i■ ■ �:■ONMO■N"ONN■ mom ■NOON ■■ now ■NOON;O� •■NOON■ ■ .■■■■■■■ ■■ ■■NEOMIN . NO■■■■■ ■■■■■�■■■■■■■■■■■■■■� ■:i■■■■■■■N■■■■■ A building permit maybe required by: Fr-! 4 , `i"1+ ; l.n ^ f �! ? .t �'{ '; ol - "t�` ❑ See note on back regarding Basin rules. •. . Notes/Special Conditions Ili., t.�L,tti.?� r River ? f .r ,Agent or Applicant Printed Name Permit Officer's Signature Signature * Please r a _ com tement on back of permit*" Issuing Date' � Expiration Date ;ApplicationFee(s) eck# t Local Planningjurisdiction' + Rover File Name 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, certifythat this project is consistentwith 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/ I-888-4RCOAST 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 Rjhu's. F'Anb!-N!-anL 91nn',,nac,� Applii adt: 3 Date: Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. Habitat Name A DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbarice-total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp lmDacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) Dredge D MIX Both 0 Other 0 Dredge[] Fill'El Both D OtherW Dredge El Fill El Both [I Other [I Dredge E] Fill -[I Both 0 Other 0 Dredge [I Fill El Both [I Other [I Dredge [I Fill [I Both* [I Other [I Dredge [I Fill [I Both [I Other [I Dredge [I Fill El Both 0 Other El Dredge [I Fill [I Both [I Other [I Dredge El Fill 0 Both El Other [I Dredge ❑ Fill El Both El Other D Dredge [I Fill 0 Both 0 Other 0 Dredge El Fill D Both D Other D Dredge [I Fill ❑ Both 0 Other [I Dredge El Fill [I Both [I Other [I rk, REMTVM MAR 1,0 MA Dcwmcrry 9 3 , 2-30v';-2z10;a : :: M nrnicAnoNror • WMoIIUW�o • • (last revised 12127/06) i / 4 a FEB 2 6 2W North Carolina DIVISION OF COASTAL MANAGEMENT 1, Primary Applicant Landowner Information Business Name Project Name (if applicablej Applicant 1: First Name GARY MI Last Name AMERSON Applicant 2: First Name MI Last Name If additional applicants, please attach an additional page(s) with names listed. Mailing Address 2008 ASBURY RD PO Box — City COVE CITY State NC ZIP 28523 Country USA Phone No. 252 - 229 -1126 ext. FAX No. - - Street Address (if different from above) SAME AS ABOVE City State ZIP _ Email kyleystreeservice20l1@gmail.com 2. AgentContractor Information Business Name KYLEY MCINNIS Agent/ Contractor 1: First Name KYLEY MI Last Name MCINNIS Agent/ Contractor 2: First Name MI Last Name Mailing Address 835 HWY 70 BETTIE PO Box City BEAUFORT State NC ZIP 28516 Phone No.1 252 - 725 - 2448 ext. T hone No. 2 - - ext. FAX No. Contractor # Street Address (if different from above) -SCIM& c7s Ci Lye - City State ZIP Email IlArt kyleystreeservice20l1@gmail.com P <Form continues on back> DCM MHD CITY 252-808-2808 .. 1-888-4RCOAST .. www.nccoastalmanagement.net • • 3. Prroct Location je .. County (can be multiple) Street Address `-'t State Rd. # ' CARTERET CO. 241 SHELL LANDING RD m- cily Subdivision Name City State Zip SHELL LANDING BEAUFORT NC 28516 - Phone No. Lot No.(s) (if many, attach additional page with list) 252 - 229 -1126 ext. LOT 21, , 1 , a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project WHITE OAK RIVER NORTH RIVER c. Is the water body identified in (b) above, natural or manmade? d. Name the closest major water body to the proposed project site. ❑Natural ❑X Manmade ❑Unknown E6 NORTH RIVER e. Is proposed work within city limits or planning jurisdiction? f. If applicable, list the planning jurisdiction or city limit the proposed ❑Yes X❑No work falls within. 4. Site Description a. Total length of shoreline on the tract (ft.) b. Size of entire tract (sq.ft.) 150FT VINYLY (SURE LINE) SEA-WALL 150 SQ FT c. Size of individual lot(s) d. Approximate elevation of tract above NHW (normal high water) or 6 NWL (normal water level) (if many lot sizes, please attach additional page with a list) 9FT ❑NHW or ❑NWL e. Vegetation on tract CLEAN SAND TYPE SANDY LOAM f. Man-made features and uses now on tract SEPTIC TANKAND DRAIN LINES g. Identify and describe the existing land uses adjacent to the proposed project site. WATERFRONT AND WATER ACCESS h. How does local government zone the tract? I. Is the proposed project consistent with the applicable zoning? (Attach zoning compliance certificate, if applicable) PERMIT ACCESS ❑XYes ❑No ❑NA j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ONo k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ZNo ❑NA If yes, by whom? I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ❑X No ❑NA National Register listed or eligible property? ;, * I m. () Are there wetlands on the site? (i7) Are there coastal wetlands on the site? <Form continues on next page> ❑Yes ❑X No DCM MHD 014 • • • ❑Yes TNo (iii) If yes to either (i) or (ii) above, has a delineation been conducted? (Attach documentation, if available) E]Yes 1C_INo n. Describe exsting wastewater treatment facilities. nCII:PXD ONSITE WASTE WATER SEPTIC WITH 4 DRAINLINES t FEB 262014 o. Describe existing drinking water supply source. NONE T)CM-Mfff) My p. Describe existing storm water management or treatment systems. NONE 5 Activities and Impacts a. Will the project be for commercial, public, or private use? PRIVATE USE O,�,Coom�mmercial Public/Govemment Lt2Private/Community b. Give a brief description of purpose, use, and daily operations of the project when complete. SEA-WALL USED AS EROSION PROTECTION. BOAT LIFT IS USED FOR CONVINIENT WATER CRAFT ACCESS c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type of equipment and where it is to be stored. SMALL MINI EXCAVATOR, GENERATOR, HAND TOOLS, NAIL GUNS STORED ON A TRAILER d. List all development activities you propose. 150 FT OF VINYL SHORE LINE SEA WALL, 2 BOAT LIFTS e. Are the proposed activities maintenance of an exsting project, new work, or both? NO NO f. What is the approximate total disturbed land area resulting from the proposed project? 450 X Sq.Ft or DAcres g. Will the proposed project encroach on any public easement, public accessway or other area Yes ZNo ONA that the public has established use of? h. Describe location and type of existing and proposed discharges to waters of the state. NIA 1. Will wastewater or stormwater be discharged into a wetland? Elyes X No ONA If yes, will this discharged water be of the same salinity as the receiving water? DYes ZNo ❑NA j. Is there any mitigation proposed? Yes NNo EINA If yes, attach a mitigation proposal. <Form continues on back> 6, Additional Information in"addition"to this completed application foim, (MP -'I) the following items below, if applicable, must be'submitted in order for the application package to'be complete. Items (a) = (9 are always applicable to any ingjor development application `Please consult the application instruction booklet on how to property prepare the required items below.: �,f f r • • • �Cf�VEA f a. A project narrative. SEA WALL CONSTRUCTION INSTALLED FOR SOIL EROSION AND NAVIGABLE WATER ACCESS SAFE. BOAT LIFT INSTALLED TO PROPERLY STORE BOATS AND OR ANY WATERCRAFT FROM STORMS OR BLOCKMBJfi /I0A 00 WATERWAYS. b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, pIatsjgC"1p4RR>RWguish between work completed and proposed. PLANNING AND PRE CONSTRUCTION c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site. d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties. e. The appropriate application fee. Check or money order made payable to DENR. f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in which to submit comments on the proposed project to the Division of Coastal Management. Name EDWARD LARSEN ., spoke to sunday night 2-23-14 Phone No. 83871378 " Address 229 SHELL LANDING RD BEAUFORT NC 28516 Name LYMAN PARTIN Phone No. 504-2064 Address 249 SHELL LANDING RD "Name Phone No. "Address g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates. WA h. Signed consultant or agent authorization form, if applicable. I. Wetland delineation, if necessary. N/A j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner) k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act. T Certification and Permission to`Enter,;on Land I understand that any permit issued in response to this application will allow only the development described in the application. The project will be subject to the conditions and restrictions contained in the permit. I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up monitoring of the project. I further certify llthat the information provided in this application is truthful to the best of my knowledge. Date ,( —1 - 19 Print Name LApi,-TA Signature irk ease indicate application attachments pertaining to your propoWd project. DCM MP-3 Upland Development ❑DCM MP-4 Structures Information t AECE M MAR 10 2014 DCM MO CITY •Ir C a5a-7a5-09�8 cell T FEB 2 6 Z014 DCH-MO CI1Y (_ Pro po S ec..-� r Qoa� ► F t Sr, I;z I f - , E, II Cenfrc clor CI? 5o? Propof ej (0 / o. 5 boos L F-r 8xla asa4y8 5code I " +. -1 .5 �ro�P�'iy �►ne rr-r-7-T� C= 0 o � Q Pco u cis ro a s e c� Sea- P eG �Q,II aw►de vInyle 6�eefs I Li ' 13Qs►n •26 )- MknPr ,nyl '�1 ►.► out 8' l 2n n% 4- .:Cool` Gllar� G VA-I`O(yN (,Jai d S }-ray c f u e e ►^r1 r S o n of Co e C► i-y I L U m Q n Reen frees+e-cl a5,.Q-0a9-1Ia6 Partin GrDu,,d Con+GGI, Dpl uetdi a `14 sk e I I 0,/ , n s 117-C dvc ComectGIS Feature Report f yr http://carteret.comectgis.com/DowrdoadFile.aslDOi= ags_mapbc56be... is • • P FIRE DISTRICT BEAUFORT FIRE PDOT 9337 PRID 0 OWNER AMERSON,GARY B ETUX KATHRYN A I II11I �ZrT.�iil I IL14W YEAR CONDO BUILT 0 MAILING ADDRESS CITY COVE CITY MAILING ADDRESS PO BOX RESCUE DISTRICT BEAUFORT RESCUE YEAR BUILT 0 BATHROOMS 0 STREET NAME SHELL LANDING 1104635 DEED BOOK 1464 CURRENT DEED DATE 20131106 STRUCTURE VALUE 0 MAILING ADDRESS HOUSE NUMBER 2008 MAILING ADDRESS STATE NC CITY LIMIT LEGAL DESCRIPTION L21 SHELL LANDING TOTAL SQUARE FEET 0 BEDROOMS 0 STREET TYPE RD aicuz OBJECTID 1 8678 CONDO NUMBEIYCI VP PIN15 2Q11� 731703209337bP2 DEED PAGED 487 I)CM.M M CITY SALE PRICE 75000 OTHER VALUE 0 MAILING ADDRESS DIRECTION MAILING ADDRESS STREET ASBURY ROAD MAILING ADDRESS ZIP 28523 NEIGHBORHOOD CODE 110029 TOTAL ACRES 0.646 ROLL TYPE R HOUSE NUMBER (7 Diaits) 0000241 CITY BEAUFORT RISK LEVEL he information displayed by this website is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats and other public records and data. Users of this information are hereby notified that the aforementioned public primary information sources should be consults r verification of the information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Cartere unty does not guarantee that the data and map services will be available to users without interruption or error. Furthermore, Carteret County may modify o emove map services and access methods at will. RECEIVED MAR 10 2014 DCM MO CITY 2 of 2 2/23/2014 6:53 PM AMERSON CAMA OVERHEAD;jpeg (JPEG Image, 667 x 752 pixels) file:///C:/Documents and Settings/user/My Documents/AMERSON CA... i arcels Updated 02-20-2014 Centerlines gE�VEU E I, County Bounda Other "ITY ^t 3 11 other I the a Cart •�� . 7a PIN 04, Acreage �o Parcel Dimensions M Lot Number f4s k k 0363 01 1C 2/23/2014 8:20 PM Property Data http://web3.mobile3l I.com/CarteretCard/default.aspx?PIN=73170320... 0 Carteret Countycl;�v>~n Property Data Parcel Number: 731703208217000 Inquiry Date: 2/23/2014 I-FQ 2 6 2014 DISCLAIMER: For confirmation of the number of buildings on each parcel, please contact the Carteret County Tax Office. Owner/Property Info Parcel Number: 731703208217000 Owner: LARSEN,EDWARD A JR ETUX REVESH Physical Address 0000229 SHELL LANDING RD BEAUFORT NC Mailing Address: 229 SHELL LANDING ROAD BEAUFORT NC 28516 Legal Description: L22 SHELL LANDING Deed Book: 874 Deed Page: 528 Sale Date: 20000119 Sale Price: 44000 Acreage: 0.712 Land Value: $130,241.00 Building Value: $167,879.00 Extra Feature Value: $6,000.00 Parcel Value: $304,120.00 Sketches OCK vo e0C1000 eS0]000 ew,e ceee R e 0CY1]O X ]SO- Building Info DCM Y.0 CITY Baths: 2 Bedrooms: 3 Condition: N/A Exterior Walls 1: VINYL Exterior Walls 2: N/A Floor Finish 1: CARPET Floor Finish 2: VINYL TILE Foundation 1: Foundation 2: Heat: HEATPUMP Roof Cover 1: COMP SHNGL Roof Cover 2: COMP SHNGL Roof Structure: GABLE Square Footage: 2250 Year Built: 2008 Click Here for Advanced Cards RECE 0MY MAR 10 2014 DC�i-h4.'i�J C?TY ComectGIS Feature Report http:Hcarteret.comectgis.com/DowrdoadFile.ashx?i= ags mapl0fdccd... TOWNSHIP 0011 0 OBJECTID 17773 MOTHER 0 OWNER PARTIN,P LYMAN JR ETUX JANE • • NUMBER 249 MAILING ADDRESS ZIP 28516 NEIGHBORHOOD CODE 110029 TOTAL ACRES 0.486 ROLL TYPE R HOUSE NUMBER (7 Digits) 0000249 CITY BEAUFORT FIRE DISTRICT BEAUFORT FIRE PDOT 363 PRID DEED BOOK 0852 SALE PRICE 0 OTHER VALUE 27403 MAILING ADDRESS DIRECTION MAILING ADDRESS CITY BEAUFORT MAILING ADDRESS PO BOX RESCUE DISTRICT BEAUFORT RESCUE YEAR BUILT 2006 BATHROOMS 3 STREET NAME SHELL LANDING TOTAL VALUE 408876 NOISE LEVEL OBJECTID 1 8672 CONDO NUMBER PIN15 MEMO 731703300363000 DEED PAGE 2 6 20 4 00469 FEB LAND VALUE 78945 C:i1:v.THD C1 Y YEAR CONDO BUILT 0 MAILING ADDRESS STREET SHELL LANDING ROAD MAILING ADDRESS STATE NC CITY LIMIT LEGAL DESCRIPTION L20 SHELL LANDING TOTAL SQUARE FEET 2793 BEDROOMS 4 STREET TYPE RD aicuz he information displayed by this websits is prepared for the inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats nd other public records and data. Were of this information are hereby notified that the aforementioned public primary information sources should be consults r verification of the information contained on this site. Carteret County assumes no legal responsibility for the information contained on this site. Cartere ounty does not guarantee that the data and map services will be available to users without interruption or error. Furthermore, Carteret County may modify o emove map services and access methods at will. MAR 10 2014 DCM•MHD CITY 2 of 2 2/23/2014 7: l4 PM lot ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1 hereby c,ertify that I o%,vn 'property 4;a . c I ent to _GA9 on- --MM o 2014 (Name of Property .Owner) Reap rij ( l_a—q_m-9D CITY (LDt, Blod4 Road, 6c.) on Rouer in o6p, N) N.C. rE-A��) 4 \lffateibody) (Toun and/or.Counly) A Address: 2S35 HotA '26 e++Ie phone 9, 9 5-Q q8lV "Add He hisdesciiWd to Me, as sho-*%M WoNv, the ,develodevelopment he is ;it tll;at kllc�i. P proposm, on, and, I have no objections to his proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPlUENT: property ownerpropasing, derep)lo=w (To beAlkd in 6� po ... ... ... .. .. ..... - " p�fa ��e� P. RECEIVED MAR 10 2014 DCU-MHDClTy �J11 60 -k Pease(S-elo 1,1 .(Information for Property !On-ner APpfs inb (Riparian Property (!i� - r rmation for P e WE Nailing Address leaoGla- N(-- city/statoop 13 A. - fdojor"-1 Print or TSpe Name _d 5o? --R 3-tq - /3 98-- - - - Telephone Number Date 5 �•-- 5 Ca ( e C f _ Ct�5j) a5 0?44 �)ro� Fr �y Lrvre Pro P05ej F Pro�ucis w ie u)nyle "T r I� lck A e I 8` Len5ti 4- Color, Graff Woad SfroCfQc Green, frea+e-,J G%uAcl Con'c,cl. 1401 4 ?I (-3 I t'1 PfOioS e� � j �T 0.5 600i br,- 5<` gx#� IProPoj s s � ea - �.Jali <511 eC' �S I Li O` V r rr u E rr n Gt e Al'ifr^sOn or Co ve C r �� a5,�-0aq-ii�6 -d zt U ri tY Q p 1 Y .f 1 u• t ADJACENT RIPARIAN PROPERTY OWNER STATEMENT /� ,� jiECEIVED I hereby certify d=1 I ov%,n proms° adj =t toW Am S ,014 (Name of opertl' Q6 pro t,%- La -f-- � ( d 4 l X e ll 1 r,4 ,1J /_&��, � �C (Let. Black, Road, etc-) (Waterbody) (T6nm nndfor County) Appli at's phone 9: _l o� Jam' of Ll � � Z%failing ,address: 3 50 '74 fit has described to me, as shown below. the ale%viopmcni he is proposing at d-at location, and, I have no objections to his proposal. DESCRIPTIOI ANT -DIOR DRAWt,%TG OF PROPOSED DEV LOP�iI:N'T: (To he filled in dot" prvprr1" owner proposing d meloprnent) (infornmtion for Property° Oss-ner Applti ing for Permit) q ed 16f, 'nt' )v Mailin- Address -11 �dr'-JG'-� AL JLrLx City St: telZip gCole Q 5Q - 5� yea y Telephone's umber C4- A 1- ure � e -T MAR 1.0 2014 (Riparian Property- Owner Information) USuture cell Print or Type Fame Telephone Number �-�940/q Daze • 0