68069D Marsh

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: o �(n �M Qso h/1� Permit #: 6g64, `Fb
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
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
Dredge ❑ R110 Both ❑ Other
!impact
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 n Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both (] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

SUPPLY
25 BLANTON RQ SE
SUPPLY
NC
28462-3590
3676160462
02/17/2017 [phone] 1:40 PM
--------------------------------------
Product Sale Final
Description Qty Price
First -Class 1 $0.49
Mail
Letter
(Domestic)
(WILMINGTON, NC 28403)
(Weight:0 Lb 0.70 Oz)
(Expected Delivery Day)
(Tuesday 02/21/2017)
Certified 1 $3.35
(I@USPS Certified Mail #)
(70161370000047329730)
Return 1 $2.75
Receipt
(1@USPS Return Receipt #)
(-@590940219126104442655)
Envelope 6"X9" 2 $0.98
(Unit Price:$0.49)
First -Class 1 $0.49
Mail
Letter
(Domestic)
(KEY WEST, FL 33040)
(Weight:0 Lb 0.` ,)
(L ted Deliver 7y)
(Tuesday 02/21/201,
Certified 1 $3.35
(@@USPS Certified Mail #3
(70161370000047329723)
keturn 1 $2.75
Receipt
(®@LISPS Return Receipt #)
(9590940219126104442648)
Total $14.16
Debit Card Remit'd $14.1E
(Card Name:Debit Card)
(Account #:XXXXXXXXXXXX3353)
O
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Domestic Mail Only
For delivery information. visit our website
at wwwusps.con)
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certified Mail Fee
$3,35
7
1462
$ - 'C
02
Extra Services & Fees (check box, add lee ADd dpte)
l]
❑ Return Receipt (ardoopY) $
❑ Return Receipt (electronic) $ $� C t I ii I
Postmark
p
❑Certified Mall Restricted Delivery $ 2+_T
Here
0
[]Adult Signature Required $
❑ Adult Signature Restricted Delivery $
0
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Postage
$0.49
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Total Postage and Fees
$ $6.59
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Postal
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CERTIFIED MAIU) RECEIPT
ru
DlOmesfiC Mail Only
NCertified
Mail Fee
$3.35
$
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Extra Services & Fees (check bar, addles ^c
eJ
I]
❑ReturnRetuReoelpt (hardcop,) $ I I ) r % ;
I3
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❑ Return Recalpt (electronic)
— —
❑ Certified Mail Restricted Delivery
Postmark
$
❑ Adult Signature R $—
Required
Here
❑ Adult Signature Restricted Delivery $
Postage
r` 4.-
m $
r--q Total Postage and Fees
)2%1 7/201 7
4�. 19