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Division of Coastal Mgt. Habitat impact Computer Sheet
licant: �l�.,c1_ ' Permit #: 5--Li (cS b
3ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat 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)
Dredge ❑ Fill Both ❑ Other ❑
Dredge [:1 Film] Both ❑ Other ❑
!�
Dredge ❑ Fill ❑ Both ❑ Other
��
U
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 0 Fill ❑ Both ❑ Other ❑

V�.
4122
HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN 661215/531
U �C /
910-842-9732 HIS NCDL 4576438 HERS 5202842 80
1502 STONE CHIMNEY RD SW
---------------
SUPPLY, NC 2"6y22r— T /��
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Supply, NC 28462 "�
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