71174A_Cornelius & rochelle Vaandering_20181106

�)CAMA / D DREDGE & FILL NO 71 174 �p;
GENERAL PERMIT Previous permit# lJ B C °
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued /
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
X Rules attached.
Applicant Name C tkE.WO KC,f}" 1MtuV21N6.,
Address I11L1i I�fr�.I (& ip
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City 1TCwn State�L ZIP �4�y
Phone # (75-7) Z S- G /// S E-Mail
Authorized Agent
Affected ❑ CW NEW APTA RAES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / rio PNA yes / rro
Project Location: County E& d it Li 11,I wthl
Street Address/ State Road/ Lot #(s)
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City 1-fa)ZIP 2— j 4 4
Phone # ( ) 5AWA: River Basin Ii1 Sr 1c.7r1/SIC
Adj. Wtr. Body CAA (nat /rrrdn /unkn)
Closest Maj. Wtr. Body �f%E �l /rf!/« ' Zllur)
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Agent or ApplicantPrinted Name Permit Officer's Printed Name
Signature)**, Please read compliance statement on back of permiOO Sigr�ure
Application Fee(s) Check # Issuing Date I Expirati n Date

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MO Division of Coastal Mgt, Habitat Impact Computer Sheet
Applicant: a�GLt`�e(,L J/�� ��vS l//�/O�j/%��.F/•U� Permit #: % ll
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
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance 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 impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
S b^ l/kv
Dredge ❑ Fill Both ❑ Other ❑
sL)o S F
z
SS F
Dredge ❑ Fill ❑ Both ❑ Other
AC V
Dredge ❑ Fill ❑ Both ❑ Other,�J
S��dS�
C5�60c) S�
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 ❑ Fill ❑ Both ❑ Other ❑
revisad.- 0210351-10

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cornelius J. Vaandering & Rochelle R
Vaandering (Name of Property Applicant)
property located at 173 Pirate Cove Way , 1-46, Hertford, NC 27944
(Applicant's Address, Lot, Block, Road, etc.)
on Holiday Island Canal, in Hertford, N.C.
(Adjacent Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca � n.
I have no objection to this proposal.
I have objections to this proposal.
You can mail any objections to 401 S. Griffin St., Suite 300 Elizabeth City, NC 27909
If you have any questions you can call: 252-264-3901
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Replacing 290 feet of bulkhead of section L46 and replacing the existing 12 x 16 dock in the
current location.
(Property Owner Infor tion
t!�
Signature
Cornelius Vaandering
Print or Type Name
173 Pirate Cove Way
Mailing Address
Hertford, NC 27944
City/State/Zip
[phone]
[e-mail]
Telephone Number / email address
03/08/2018
Date
(Adjacent Property Owner Information)
Si nature
Dennis & Rachel Bisson
Print or Type Name
36 12th Street
Mailing Address
Berlin, NH 03570-3863
City/State2ip
(co3) ?a 3 1w���yl,
Telephone Numb r / email address
S-15-1
Date *
(Revised Feb 2017) *Form is valid fOr one calendar year after :jig nature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cornelius J. Vaandering & Rochelle R
Vaandering (Name of Property Applicant)
property located at 173 Pirate Cove Way , 1-46, Hertford, NC 27944
(Applicant's Address, Lot, Block, Road, etc.)
on Holiday Island Canal,
(Adjacent Waterbody)
in Hertford, N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x ('I I have no objection to this proposal.
I have objections to this proposal.
You can mail any objections to 401 S. Griffin St., Suite 300 Elizabeth City, NC 27909
If you have any questions you can call: 252-264-3901
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Replacing 290 feet of bulkhead of section L46 and replacing the existing 12 x 16 dock in the
current location.
(Property Owner Information)
,--4 �
- Z-0�
Signature
Cornelius J. V andering
Print or Type Name
173 Pirate Cove Way
Mailing Address
Hertford, NC 27944
City/State/Zip
[phone]
[e-mail]
Telephone Number / email address
03/08/2018
Date
(Adjacent Property Owner Information)
Signature* <f6t;4i4 64
Ralph & Sandra Atkinson
Print or Type Name
113 Little John Road
Mailing Address
Williamsburg, VA 23185
City/State2ip
2--3
Telephone Number / email address
3 - 01—z15ne t3
Date *
(Revised Feb 2017) *Form is valid for one calendar year after signature*