HomeMy WebLinkAbout72689A_Jeff Oden_20190701'No. 72689 4
B C D
"MINIC]IMPAL. Vt:rIIVII III
i _�Partial Reissu
bd?'New �JModiftcation I JCornplete Reissue ��
As authorized by the State of North Carolina, Department of Environmental Quali
and the Coastal Resources Commission in an area of environmental concern PLJI'SU
Applicant Name
.. . .......
,address,11 _'�t
City_
State
Phone # `V//`;
E-Mail
Authorized Agent
[,-I Cw
1 4 FW
i �I PTA [`,J ES ,j PI-S
Affected
AEC(s): I ;OE A
0 HHF
1 1H IUBA 1 1 N/A
i PWS:...-------
OIRW.- yes / 6o,"I",
PNA
yes d fib
Type of Project/ Activity I L � ........... .
. ................. . . ......
. . . . . . . . . . . . . . . . . . ........................................... . ....... . .. ............ . . . . .... . ......... . . ...... ... . . .. . ...... ........ - ........ ._ (Scale:
Pier (dock) length
Fixed Platforam(s)
Floating Platforrn(s)
Finger pier(s)
Groin length
number'
l ulkhezpdl Riprap length
avg distance offshore
niax distance offshore
Basin, channel
cubic yw'ds
Boat ramp . .. ....... ............
BoathOUse/ Boa d A
Beach BOdozing
Other
f
7 7�"
Shoreline i ength y
. .. . . . . .
SAV: not sure yes 11'e,
moratoriuni: / 'n'/a t yes no
Photos: 110
Waiver Attached: Yes ho ........... .. ... ........ — - - - _-
A building peniiit may be requfi-ed by:
( Note Local Planning Jurisdiction)
it otesl Speciall Conditions
[ I See note on back regarding River Basin rUleS,
WC Division of Coastal Mgt. Habitat Impact Coniputer Sheet
.Applicant: -gfYh Permit#:
Date; "'YJAA, t I Q
Describe below the
HABITAT disturbances for the application.
All values should
match the narne,
and units of
measurement
found in youir Habitat
code sheet.
.
. ......... . ... . .....
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated Nnal
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration anclVor
restoration or
and/or temp
restoration or
temp impact
em im acts
impact arn u1
i
Dredge [I Fid Both E] Other E]
Dredge E] FiR El Both � Other [I
......... .
Dredge El Fill El Both [fl Other E]
Dredge Ril ❑ Both El Other [I
Dredge ❑ Fill ❑ Both 0 Other El
Dredge Ej R11 ❑ Both [11 Other
. . ........ ..
Dredge E] Fill E Both D Other Ej
Dredge[] FiR E] Both ❑ Other n
Dredge [:] Fill E] Both ❑ Other 0
- ----------
Dredge E-] Fill Ej Both [:1 Other n
. .
. . ...... ... —
. .....
Dredge 0 Fitt L] Both [1 Other 0
DredgeE] F010 Both El Other F-1
.. ....... . ..
Dredge C] Fill El Both El Other El
Dredge E] Fill E] Both E] Other El
Dredge Ej Fill [I Both Ej Other [I
L-
252-808-2808 a-, 1-8884RCOAST :a w w&, n c coa sta ln-iari�j p nripri t-. rip t revlsedr 02/0110
0
Name of Property Owner Applying for permit C)r7lq-- 0--A4)
Mailing addrew- RO ffOX 37cl
OATTIC-94S, AIC. Z7nq3
Telephone Number: ZS-Z- 175-- 0-973
JEA1AJIFC-R PRICE c(
I certify ftt I have authorized GA)Z'1PKMC'
kageffl/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of NZ1ZK14EAj) ) 111C-R
A AJ D MObl?IN6 Fl� jff5
at my property located at -T7/ 9 B IS IIAJ 6 TOA/ C f I-1A 77FR&', AZ Z? 34t3
This cedffication is varld through 3/1 201 D _._ (date).
ME=
Sgnstare
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�W�" Or �pOrOpD�Oorty
Title, co. o;W;Wner or trustee
Date
Telephone Number
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A _2 UNITEDSTATE
S
POSIALSERWE'
March 27, 2019
Dear gary price:
The following is in response to your request for proof of delivery on your itern with the tracking number.-
7018 0360 0001 6770 0206.
Status:
Delivered, Left with Individual
Status Date / Time,
March 22, 2019, 1228 pm
Location:
ELIZABETH CITY, NC 27909
Postal Product:
First -Class Mail'�'
Extra Services:
Certified Maillm
Return Receipt Electronic
777 �7 7
Weight: 1.0oz
7,
Signature of Recipient:
Address of Recipient
Note: Scanned image may reflect a different destination address due to Intended Recipient's delivery instructions on file.
Thank you, for selecting the United States Postal Service"" for your mailing, needs. If you require additional
assistance, pllease contact your local Post Office'" or a Postal representative at 1-800-222-1811.
Sincerely,
United States Postal Service"
475 L'Enfant Plaza SW
Washington, D.C. 20260-0004
U N1 TED S Urt.'S
POS IAL SER VICE
The following is in response to your request for proof of delivery on Your item with the tracking number:
7018 0360 0001 6770 0215,
. .. .. . . .
6
Status: Delivered, Individual Picked Up at Post Office
Status Date / Time', March 23, 20,19, 11 -.55 am
Location: HATTERAS, NC 27943
Postal Product: First -Class Mail"
Extra Services: Certified Mail TM
Return Receipt Electronic
Weight: 1.0oz
7T
Signature of Recipient
Address of Recipient
Note: Scanned image miay reflect a different destination address due to lntended Recipient's delivery instructions on file.
Thank you for selecting the United States Postal Service' for your mailing needs. If you require additional
assistance, please contact your local Post Office TM or a Postal representative at 1-800-222-1811.
Sincerely,
United States Postal Service
475 L'Enfant Plaza SW
Washington, D.C. 20260-0004
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ti THOMAS E, TODD
57198 ISLING ON CT. 57194 ISLINGTON CT.
kIATT I AS, NG HATTERAS, NC
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