77266_John Cliatt_20201006

j.. .__•»_,...._r ...tre
71,- tik3/4-11047Z1 a rINVKI-
t Mit }
mops cog u°wpm asio4 a-, i �-'A I4 rumbas aq Amu awed flapproq v
1 1,..., .,4- ,- , _,_.- . .; . ,,,ii to---t-- - , ;GI,. 7 -r :...:4.--#, airt rod mippost,344
■LINT �inglgaPV I t re ' ; 1 _ , cep ,� ^
An
ISOM
usiii am!!i fig NHL gilkiftripilli iiiitil IN iii.N, impi 1 AM.' --
■ - Mill -.
MAMI11 ar _. , 7 " ,gi g
iii
. -- , , ,
. , ,
, ,_ : , ...„._ _4 _ : : i 1- - ;— -,, ----,-, -f-- , woos Pegoalses
_+ i : i I 4k. ,s; - -, ' i ,4 . 1 . , T 1.1.4._. 1,. .„;.±...„—_, _ __ _______
Egh . _ ....,._ _ .i. , ,
1 i +. #, ,. a �.. f + ...*�-�+-•� !' ., ,..._ —T"
j We
,
1 1 ,-fai .
t
4 ✓.. ..
i 1
Iliplim.
f t 1 t ! `^'A�4"40t as
.. __..1 4- _ _ 1 _Tom►_.�_. —�•�'_ +---_ ..V.. L
!
i *MI*Ad alnIllni
_ _ ! ' !-- .,. .!! __ _
1 x _
a
—_. - 4 . ._ , �OZ i
_. __L_.__.- ` _1-1 . .r .,,.,._.1 ._-.. _�.... .—,au
4pose
( off ,/ -7 7
gu(g)ippild &oat Aso
"VW 47
— s/.c//v emu,
A_hro VdN r MID MO *MC VOW-)
. 'V r7 Wag Al"111 L ) •ouNd use J sat' viapi M *opt Plimlw
_ **-s.cszda .., . ,�.:,� _ #.rid 'rit. 3U•k►PDXPOIPTP1f
/-y "'1 °"�`� 9sLsZ „la-"ry ions tin, C3 -1' t w
2 st S ($)i Jai Pen awn igrai r r=tuS _ 1 -'`i?, o C.
7 ssa4,PV
vapors�.. V ..Alu °t' -u4!7�1 +d -. —__._ _ i marl p+ ►
► Dy3Nysi as wafnme tAAMICI,psumusucusokus p nee MI II kaupepamoD swnosoy ,3 ap pun
.11,►A consv 3uu,ad stlowaud c'?Czi
otiruww frame anss078 ate~ 1 110411301X11411 if i

1
er/IfCAMA / DREDGE & FILL N° 77266 A 0 C D
ENERAL PERMIT Previous permit# it./A-
) New ❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued /V
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 I 5A NCAC /T t/ Z -Z
/ Rules attached.
Applicant Nameyp1 e//a Project Location: County p
Address 37 0 --8;5 Leve-'I frif, Street Address/State Road/Lot#(s) 5 3 2 ' , 3
City 01.1 it 1 1C'"N-1 State NL ZIP 28756 L ;el 6Z�•
Phone# ( �� E-Mail Subdivision '—
I-
Authorized Agent , 6 % City P1�✓''4T ZIP 2$5 5(7
Affected XCW EW XPTA ❑ES ❑PTS Phone# ( '—)- - River Basin A-42.4ti. f
AEC(s): ❑OEA ❑HHF El IH ❑UBA ❑N/A Adj.Wtr. Body /j.// e/C{ an /unkn)
❑cc
ORW: yes co / PNA es / no Closest Maj.Wtr. Body Arc'.
Type of Project/Activity hr(14i,-,‘. U rq'''''`"5 -1•o v s-wi-LD 1 2-7C Z o ' --1a-111-7� 7 by LI-
-/ /6 /
L / l 0v f (Scale: /.' 30 )
Pier(dock)length A, l
Fixed Platform(s) ( 1 1 i i
Floating Platform(s) /2 f 2 O I I
,
Finger pier(s) i ! f�._..........._ i -.
Groin length , { �t -
Bulkhead/Riprap length
-, F- -- _._.._.._ - -*
avg distance offshore
I
max distance offshore !
Basin,channel i f I j I
I t
cubic yards I ; i
Boat ramp I !
Boathouse/Boatlift i _ -_._..._._ _ H_...__.....__..._......-._�-
f -
11
FIw `� 11, f
Beach Bulldozing �� 2+0 �C�Other
II t ` l
f , i i \ i `
Shoreline Length 4 �Oa 1I/ / 1 Y ,.r
Y Y` �f Y . y' (i
SAV: yes no Lfr - ILk I/
Moratorium: n/a yes I i 1 _ S
Photos: yes + } -
i i (p .._
Waiver Attached: 40 o r i
i
A building permit may be required by: T�--(1 Co• . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) /� y /� / f(
ob• 'L�D 7-L e+ /�a �lrr_-
Notes/Special Conditions u B 5 V
f
4/ i
Agent or Applicant Printed Name Permit Officer's Print ame
Signature **Please read compliance statement on back of permit** Signa e
AP, „Qofl•ems` -g35o /cI. L 2 Z — fc,6 . G 2A2/
Application Fee(s) Check# Issuing Date Expiration Date

.
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 I)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,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules 1 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

erCAMA / -DREDGE & FILL No 77266 A ,i0 C D
GENERAL PERMIT Previous permit# 4,
New Ill Modification ❑Complete Reissue ❑Partial Reissue . . '`{ Date previous permit issued if7
►,
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 I 5A NCAC —/" i/2-d L-1
/� , I Rules attached.
'
Applicant Name GA L; h a T/ Project Location: County Fi:.,I,r_D
Address - 7 r' 7 Lev e J l<(l, Street Address/State Road/Lot#(s) 1 i .L-fy
City / 11 I I ji);, ,�-\cl S State NL ZIP 2 S 756 I Y . i`
Phone# ( ) E-Mail Subdivision
Authorized Agent , /,f�/- City I !!i . ''lT ZIP 'L 5 (
�CW IXEW j�(PTA ❑ES E PTS Phone# ( --)---- ` River Basin A.,/, r,, —
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/Anat
AEC(s): Adj.Wtr. Body / r7// ({ �Jman /unkn)
IDPWS:
ORW: yes / no PNAeno Closest Maj.Wtr. Body 4 $ '' 'e'j
Type of Project/Activity fi.''- J'(n,-1 J, :?c'--c ' i ,^.c--. 7 c ! 'r,,;L,- ? �, E
..,../ (Scale: r J U )
Pier(dock)length ,; , /
Fixed Platform(s) ...-7-- ( j ; i
Floating Platform(s) /2/ 2 0/ i 1 _ N
Finger pier(s) '
Groin lengthc i f._ ll ` ,11
i i t
number — i............._._ .. -._._... —.....__. _.....
Bulkhead/Riprap length t — —
I - i 1 '
avg distance offshore
{ i
max distance offshore i I
Basin,channel
I
cubic yards "
Boat ramp I I 1
Boathouse/Boatlift �. r— .. —__..... __ t + �._ _ . _
.
Beach Bulldozing I �r�� — ? -( �, . c D
Other jl V ! � r a� i 14?!" f e"
4.
Shoreline Length, 7 Y % i e,,. 1. 1 I y
SAY: not sure yes no �� Y ` } • ❑1c..._: 1{ !/
Moratorium: n/a yes o t 4 . I ili 4-1--- r t o
Photos: yes Aar ......... t...._-.--_-- �.. -
Waiver Attached:•
� t6o
ll
A building permit may be required by: (1 c o (O . 'See'note on back regarding River Basinrules.
(Note Local Planning Jurisdiction)
/
Notes/Special Conditions r '--- .- 2//c -I j ,;'c',4_ -, ,,
,// /(G/+
Agent or Applicant Printed Name PermitOfficer s Pri ame
Signature **Please read compliance statement on back of permit** Signa e
l %"1, - -. jri' 2,, ? O — f-eL . r- , 2cc2 /
Application Fee(s) Check# Issuing Date Expiration Date

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 I)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,certify that this project is consistent with 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 Resources. Contact the Division of Water Resources 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
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
40 I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 9I0-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves: Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

• jCAMA
/ . DREDGE & FILL N° 77266 A BCD
GENERAL PERMIT Previous permit#
>Z =❑New ❑Modification El 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 I5A NCAC
,Q Rules attached.
Applicant Name r 0n (_ I/c i T IProject Location: County
Address ` / l / ` Street Address/State Road/Lot#(s)
City State f ZIP
Phone# ( ) E-Mail Subdivision _
Authorized Agent City ZIP
Affected XCW ❑EW [1PTA ❑ES ❑PTS Phone# ( ) River Basin
AEC(s): ❑()EA ❑HHF Li IN ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes /,no Closest Maj.Wtr. Body '-.' ' I j
Type of Project/Activity
(Scale: / )
Pier(dock)length /,, '
Fixed Platform(s) �"' -'-
Floating Platform(s) / ' ` 1 "--- ----.,
f 1 i Ni
Finger pier(s) I _ - -
Groin length I f
number - .,- - -
r
Bulkhead/Riprap length ‘\ - -1--.._.f_.-_--------._-.__._-_ �.._...__.. : i- ^^ . ...k--..!.._._....._._ r
1 1
-I ;
avg distance offshore ` ( i
max distance offshore } 1 ���
Basin,channel I ; i ! i
cubic yards / C j
t._--.___- 1 ,
Boat ramp / i
Boathouse/Boatlift /
?- — - -- - - - i..._._. - -r -t +- -).....� - -
t
__... -f{ t-.- -
-
Beach Bulldozing _ \ '�.:,, t r" I -- - -r I,-,,; r, ;�i "
Other ' l _ I f /1 1,
,
Shoreline Length 4- '1! I 1 `�'
T 1
SAV: not sure yes no } l��'�t
i 1° _ l --i-- 1 -I I . -- _ —
i
Moratorium: n/a yes no �•�••-+ I' -1-, _ : tom-- " +-' t-- 1 ' ' + E -f- - I
Photos: yes no C r1- j i! - ._ _-._ 9
Waiver Attached: yes no i ( i 1
A building permit may be required by: . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions •
/
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check# Issuing Date Expiration Date

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 I)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,certify that this project is consistent with 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office(9 I 0-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
40 I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY DGedtur
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 & .0259. The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party (contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to $25,000 per day per violation.
1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width:The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
• Pre-project site conditions: l67 /S /9'-)M. �v�
&L./ WW SIN S/��os
By your signature below you agree to be held responsible for meeting all of the conditions lis above and verify
that all information provided is complete and accurate.
AgTuft 1_- Cd�
ent or Applicant Printed Name ermit Offi s Signature
/4-C 1 0 G/ 2 �
g D 2
Agent or Applicant Signature Issue ate
CAMA GENERAL PERMIT#:
State of North Carolina l Environmental Quality I Coastal Management
Washington Office 1943 Washington Square Mall Washington.NC 27889 1252-946-6481
Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-3845 1910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City,NC 28557 i 252-808-2808

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. A. Sig ture
• Print your name and address on the reverse 0 Agent
so that we can return the card to you. X � �-v/ ��'/� lc ❑Addressee
• Attach this card to the back of the mailpiece, B• ceived by(forintt�� -
d f4rn C. Date of Delivery
or on the front if space permits. Ll 1 (�(, - 9--,2 i- € V
1. Article Addressed to: D. Is deliverjddress different from item 1? pwt �es
Nat6
�fj. . , ��'1 If YES,enter delivery address below: El No
l O 15 ercri.xi Pd.
c.v-r\a-h-tawiel, uCg►alq SS
11111111111111111111111111111111 I II I I �0 ddu
uleice Type t SSignature 0 ignature Restricted Delivery 00 RregisExpress®
te dll Mail Restricted
0 Certified Mail® Delivery
9590 9402 5134 9092 1428 88 0 Certified Mail Restricted Delivery 0 Return Receipt for
❑Collect on Delivery Merchandise
9
Grtirlp Number(Transfer from service label) 0 Collect on Delivery Restricted Delivery El Signature ConflrmationlM
ad Mail 0 Signature Confirmation
7 019 0160 0000 7850 1254 ad Mail Restricted Delivery Restricted Delivery
$500)
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

USPS TRACKING#
First-Class Mail
r II 270 I 11 I Postage&Fees Paid
•I I II 11 I; I USPS 1 Permit No.G-10
9590 9402 5134 9092 1428 88
United States •Sender: Please print your name,address,and ZIP+4®in this box
Postal Service
B PRESCOTT MARINE CONSTRUCTION,LLC
PO BOX 874
ORIEN T Ai.,NC 2c3571
uflrlf���rrr�rrr�rr,frr�lrlr1r�rf rr�lnr�rrr�r�frr���rf�r�rr�fr�
1

I
ADJACENT RIPARIAN STATT
;heieby Ceilily tiut 1 awn rzopatly a:Tomei-10 ib-k tet 01 At
gurgn 11_1 Property
pity lo,- :ad at. '5.i . "Daytess,411668.4 r"..Road. ) ...____ ____
iiCOW-) au-kJ
•7. '11-01e---r-Lai _,
I 4a... (WaterbodY) , iCity!'own andfor County)
i no appinanl has dibed to rre,3$elle.ma oelow. the doyz!oprrent propc,a- al tie above
tocardrn
i have no objecon lc this t..:•4.a.g....1,
!ha-az-.ohiedbra.3 fins Prni-
DEscavnou AND=DRAWING OF PROPOSED DEVELOPMENT -""------
grarreadetti prepostatriMii/ftaiialli le dewcdpfgaabetcatfiahkka-iae- -
Clali PrOr Hy Oicic.ok-
4 . .
/
-
,.
&--2o' )
c—c—
.
•
PrOpared Fioccii p-d._ 41-1-e_ . (cc.6,-„Crec.L
L__.,----
"-WAIVER-SECTION
I teyiera—uand 7i"- a :el_.eteJCIA-iaderi.v Weis bilk.tamp.-37eak.V.Ve.27. beaLiNts..rce,Ira,or grr..-31
rrizmzt be -pr.- beck a TrAr±nuir:distance of 1!'torn:fly wee i:EF fitial a ---ss miess-wohlet bv
ine.Of la:ii..1 weil-i' - :i vr.s•ive the 5... tnick,you must initial the 4.4.11•4.-:ia..A blank Solely.)
/ I do wish to waive the 15'solbac raoskw-ort
I do not wish ti waive the 15 setback requiTstrent
(Property Owner Infonnation) tAdjacr Property ii!,-bi „;.,I, 0
....._
FiYielnid. 4W1 -41---- ....--
fflg.naiwre ' *lute • •
Pik,cr *
4
.....
Voli,;-*Ad-in= M...."-if r t z g AlAp-uz.b
c.,...t.i.,-stabeet,
CtEMWD7.-...v
i'eicotniv Mitioarientegathrws Tospbsno:Itterf entral
'
i"-`•;'&1:401,:-lia n-1....;
-4.1;57-d br xte cp___ dar yea-Are.signafte _

L

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Oh 1 al at
Mailing Address:
Phone Number:
Email Address: /� �^ /
I certify that I have authorized • ReSC01 f l '�a rl o l✓ Congru ch
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: hS+i l I i r c oa-f-r-1.5 cte- cti locul
at my property located at 5 ?U Pails La_ma ( 1.1 irr r'Y/7 ,
in PO Y14 I((0 County.
I furthermore certify that ! am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application_
Property Owner formation:
Signature
Print or Type Name
Title
Date
This certification is valid through /0? / 8) /cO&

MC Division of Coastal Mgt Habitat impact Gombuter Sheet
Applicant 4.A.A-- %c:
et. -4-
Date: 10 t o /Zm z c-
General Permit*.: 77,2 e E
Describe below the HABITAT disturbances for the application. All values should match he lame,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq. Ft. I TOTAL Feet I FINAL Feet .
I (Applied for. (AnticipatedFeal i (Applied for. ' ;Anticipated!inal
DISTURB TYPE ! Disturbance total disturbance. i Disturbance i disturbance.
Habitat Name Choose One ncludes any Excludes ry total includes I Excludes any
anticipated :estoratior any anticipated restoration and/or
restoration or and/or ern restoration or temp impact
temp impacts) impact am cunt) temp impacts) amount)
I I I I
. 7 �
��. Dredge❑ Fill'] Both ❑ Other /© 2-4C7 ---- ..
( tt,(,J Mell3 H Dredge❑ Fill ei /71 6 (-7' r' '.. .'.. . .,......
! ! I I
l i
Dredge] Fill!] Both (' Other ❑
I
Dredge❑ Fill 7 Both E 1 Other EE
• Dredge E] Fill'!I: Both Li Other ❑
. Dredge 7, Fill 7 Both ❑ Other ❑ ,
Dredge❑ Fill 7 Both 7 Other ❑
Dredge 7 Fill ri Both ❑ Other 0 !
•
Dredge❑ Fill 0 Both ❑ Other 0
Dredge❑ ;ill Ti Both E. Other ❑
Dredge ET Fill❑ Both ❑ Other ❑ •
Dredge!7. F?il.❑ Both ] Other ❑ j j
i
Dredge❑ Fill 7 Both ❑ Other ❑ ' I•
i Dredge:] Fill El Both ❑ Other ❑