HomeMy WebLinkAbout14-03D B&B Marine Construction LLCn
AG"A
RESEW
North Carolina Department of Environment and Natural Resources
Pat McCrory, Division of Coastal Management
Governor
June 25, 2014
B & B Marine Construction, LLC
c/o Mr. Brandon Grimes
P.O. Box 2574
Surf City, NC 28445
John E. Skvarla, III
Secretary
RE: Closure Letter
Payment of Proposed Penalty for Violations of the Coastal Area Management Act,
Committed in Pender County
CAMA Violation #14-03D
Dear Mr. Grimes:
This letter will acknowledge receipt of your Money Order #1139200122, in the amount of $497.00, dated June
18, 2014 ($47.00 overpayment applied to GP 63955D). Once the amount is credited to the Department of
Environment and Natural Resources' account, this matter will be fully and completely closed.
Thank you for your cooperation in resolving this violation. If you have any further questions concerning this
matter, please contact me at the Wilmington Regional Office, (910) 796-7215.
Sincerely,
Debra D. Wilson
District Manager
DDW/ph
cc: Roy Brownlow, Compliance Coordinator
WIRO File Copy
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: 910-796-7215 \ FAX: 910-395-3964 Internet: www.nccoastalmaiiagement.net
rn
RECEWED
N 3 0
CM-MBD crrn
An Enuat Opportunity 1 Affirmative Action Employer
DCM ENFORCEMENT TRACKING REPORT
WLPJComp
j 4 ALPO
�P_
y, Violation Descripl
Initial Discovery Date
Violation [�escnption
4 I\. .t (
Respondent Name(s)
Address
Phone #
Issuer `�
4Rep.� �, ❑Violation Case No.E3�PermltNo.(if applicable)
M
Prior CAMA or D/F Itiq Yes / N PriorCase
City.,....,:.,.,..._...._�.�.
Fax #/Email _
State Zip
Violation Type: Project Type: Authorizations Required: Site Visits Respondent Site Visits Respondent
Present Present
❑ No Permit � Private/Community � Major � CAMA I .
Permit Condition ❑ Govt./Public ❑ minor ❑ D&F a O ❑
Expired Permit ❑ Commercial neral 0 ❑
j�Inconsistent w/ Rules ( 6 ❑
T� Tier Level: I II III
Violation Location and Site Description
Project Location: County
Street Address/ State Road/ Lot #(a)
Subdivision
City V V ZIP_
Phone # -o) aver Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body ,1\,
NOV Date Initial Req. Comp. Date
CNOV Date (Q .25 . + y Date Comp. Observed
Penalty Assessment
Sent to Respondent Date —` 'O" 1 • �'" App./Permit Fee
Rcvd. by Dist. Mgr. Date Penalty
Assessment Extended Yes No WillfuUlntent.
RECEIVM Continuing
Investigative
h
JUN 30 2014
Lat/Long
Shoreline Length
SAV: Not Sure Yes
Sandbags: Not Sure Yes
PNA: Yes Adjacent
ORW: Yes No Adjacent
Crlt. Hab. Yes No 11
Photos
Waiver Required Yes
In DWQ Buffer Area Yes No
Specify DWQ Buffer if applicable:
Extension Granted
L Restoration Letter
N y'�
in a„ Atr Pd�1
Yes No
7J.0409 Ref.
Recomm. Assess.
DCM Assess.
$ ' 1J
$
$ ��
$
is
is
Tolal
145T --
DCM-MHD CPPY
Formal Assessments, Appeals and Reductions
Date Long Form Submitted Assessment Appealed: 1'es No
Date Formal CPA Submitted
Final Assessment$ Date Q Penalty modified
Attorney General's Office for Injunction or Formal Collection
Date sent to AG Respondent not responsive to penalty/NOV Injunction to complete restoration
Date Collection Letter Sent Date Demand Letter Sent
Violation Activities and Impacts
AECs Affected: �� Wetlands Impacted? Yes No If yes, which types:
CW (EW PTA ES PTS
OEA iiRF UBA NIA SA DS CJ SY JR LS TY
PWS: FC: SS SC SP IF BF 404Cb
All
� j�
V rV i
Other: J
Restoration Required by the Respondent
Dimensions in excess
of permit/ unauthorized activities
Dimensions to restore
Final
allow d
Actually
y restored
kbetlorienAFdv
.ate -
NOTES:
Closing
Payment Received $ Date Date Case Closed
4
OWN
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvada, III
Governor Secretary
April 29, 2104
CERTIFIED MAIL 70110110 0000 9947 2512
RETURN RECEIPT REQUESTED
B & B Marine Construction, LLC
c/o Mr. Brandon Grimes
P.O. Box 2574
Surf City, NC 28445
RE: CAMA VIOLATION # 14-03D
Dear Mr. Grimes:
RECEIVED
MAY 6 2014
DC:ve%"D C:Ty
This letter is in reference to the Notice of Violation dated March 14, 2014 that Tara MacPherson, representative
for the Division of Coastal Management, issued to B & B Marine Construction, LLC for violation of CAMA Major
Development Permit No. 62542D, which was issued for development on property owned by Ms. Catherine Kelly
located at 501 South Topsail Road, Pender County. The violation involved Estuarine Waters and Public Trust
Areas, which are Areas of Environmental Concern designated by the Coastal Resources Commission.
The Coastal Area Management Act provides that a civil assessment of up to $10,000 plus investigative costs may
be assessed for any violation. It is the policy of the Coastal Resources Commission to assess a civil penalty for
all violations in order to recover some of the costs of investigating violations and/or to compensate the public for
any damage to its natural resources.
Under the rules of the Coastal Resources Commission, a proposed civil penalty in the amount of $450 is
appropriate for this violation. You may expeditiously resolve this matter prior to the assessment of a formal civil
penalty by accepting responsibility for the violation and paying the amount proposed above. In order to do this,
you must: (1) sign one of the attached copies of an "Agreement to Pay Civil Assessment;" (2) attach a check or
money order for $450 made payable to the North Carolina Department of Environment and Natural Resources
(NCDENR); and, (3) return the signed agreement and payment to this office in the enclosed, self-addressed
envelope within ten (10) days of your receipt of this letter. Upon deposit of your check in the Department's
account, you will receive a Notice of Compliance officially closing this enforcement action.
If you do not send a signed agreement and payment to this office within ten (10) days, the Director of the
Division of Coastal Management will formally assess a civil penalty against B & B Marine Construction, LLC.
You will then have the opportunity to request a hearing on the penalty or request settlement of the penalty.
127 Cardinal Drive Ext., Wilmington, North Carolina 284053645
Phone: 910-796-72151 FAX: 910-39539641 Internet: www.ncooastalmanagement.net
An Equal opportunity 1 Affirmative Action Employer- 50% Recycled 110%" Post Consumer Paper
B & B Marine Construction, LLC
April 29, 2014
Page 2
Thank you for your time and cooperation in resolving this important matter. If you have any questions, please do
not hesitate to contact me at (910) 796-7266.
Sincerely,
Debra Wilson
District Manager
Enclosure
TmIDw
cc: Roy Brownlow, Compliance Coordinator, DCM
Jason Dail, Coastal Management Representative, DCM
rMRECEIVED
AY 6 2014
DCM-MHD CTTV
127 Cardinal Drive 6d., Wilmington, North Carolina 294053845
Phone: 910-796-7215 \ FAX: 9103953964 \ Internet: www.nocoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer— 50% Recycled \ 10% Post Consumer Paper
B & B Marine Construction, LLC
April 29, 2014
Page 3
CAMA VIOLATION #14.03D
B & B Marine Construction, LLC
AGREEMENT TO PAY PROPOSED CIVIL ASSESSMENT
I understand that the staff of the Department of Environment and Natural Resources will propose the assessment
of a civil penalty in the amount of $450 against B & B Marine Construction, LLC for violation of the Coastal Area
Management Act, NCGS 113A-100 et sec, committed on or near property located at 501 South Topsail Road in
Pender County, North Carolina. In order to resolve this matter with no further action or expense on my part, I
accept responsibility for the violation, on behalf of B & B Marine Construction, LLC, as described in the Notice of
Violation letter dated March 14, 2014, and agree to pay the proposed civil assessment of $450.
DATE
SIGNATURE
ADDRESS
TELEPHONE NUMBER
rnRECEnD
AY 6 2014
CM-MHDC17y
127 Cardinal Drive Ext., Wilmington, North Carolina 284053845
Phone: 910-796-72151FAX: 91039"96411ntemel: www,nocoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper
CM ENFORCEMENT TRACKING REPORT
Rep.
Violation Descripi
�f Initial Discovery Date
Violation Description
IssuuJer Violation Case No.
Permit Na.
El (if applicable)
or D/F Vigl4tion$,; Yes /
RespondentName(s) Y\I\,V lV\1C `l_.Il`V3r0A"UYI t IV �,V LanaowneriAgenu ono
Address. City ,,, ,_a State__ Zip
Violation Type: Project Type: Authorizations Required:
No Permit Private/Community Major CAMA
Permit Condition �� Govt./Public Minor C: D&F
Expired Permit El Commercial neral
' Inconsistent w/ Rules Tier Level: I C II III
Violation Location and Site Description
Project Location: County
Street Address/ State Road/ Lot
City.. \I� V i \
Phone # Its
Adj. Wtr. Body
Closest Maj. Win Body
NOV Date V 0 Initial Req. Comp. Date
CNOV Date Date Comp. Observed
Penalty Assessment
Sent to Respondent Date 'O l L Ee
Permit Feelty
Rovd. by Dist. Mgr. Date
illfuVintent.
Assessment Extended Yes No
W
Continuing
Site Visits Respondent Site Visits Respondent
`I Present Prees-yent
Lat/Long
..
Shoreline Lengthur
SAV: Not Sure
Yes
Sandbags: Not Sure
Yes N
PNA:
Yes N Adjacent
ORW:
Yes NoAdjacent
Cdt. Hab.
Yes No
Photos
es
Waiver Required
Yes
In DWQ Buffer Area
Yes No
Specify DWQ Buffer if applicable:
Extension Granted
l VI� Restoration Lister
_ 'AaA fl., . A?Jepll rUe Pj
Yes No
7J.040g Ref.
Recomm. Assess.
DCM Assess.
$
$
$
Is
$
Total
1 ,5Z
Formal Assessments, Appeals and Reductions
Date Long Form Submitted Assessment Appealed: 1(es No
Date Formal CPA Submitted
Final Assessment$, Date
Attorney General's Office for Injunction or Formal Collection
Q Penaltymodified
Date sent to AG Respondent not responsive to penalty/NOV `Q Injunction to complete restoration,
Date Collection Letter Sent Date Demand Letter Sent
Violation Activities and Impacts
AECs Affected: ���� Wetlands Impacted? Yes No If yes, which types:
CW (EW/ PTA ES PTS
OFA RRFF�� USA N/A SA DS CJ SY JR LS TY n
PINS Fc: SS Sc SP IF BF 414
Other: �',j, (fly_
�IIXn—
Restoration Required by the Respondent Yes / No VA
Dimensions in excess
of permitt unauthorized activities
Dimensions to restore
Final '-
allow d
Actually restored
.,stMM
`.rh
i
�s �-
`ii`
NOTES:
Closing
Payment Received$ Date Date Case Closed
DCM ENFORCEMENT TRACKING REPORT
1 Issuer Violation Case No.
IF,iem'dPRep. 1 Eloliance Ike
0 J Permit No.
(if applicable)
Violation Description J Was
Initial Discovery Date ` Discovery
M ho`(d-
Violation Qescription 'n `p( .1(`MVA.
or D/F YtplAGon&Yes / Nq , Prior Case
Respondent Name(s) J rr_VA�ILysY "[.Il`V.Vlk_V Al�„_Yl \ Iv%,YVW 2(Lanaownenngenv-om
Address City .,....., _ ,..�� State_ Zip
Violation Type:
Project Type:
Authorizations Required:
SRe Visits Respondent Site Visits
Respondent
D: No PermitPrivate/Community
Major
� CAMA
Present
Present
( Permit Condition
Govt./Public
Minor
-C. D&F171
a'
0
Expired Permit
13. Commercial
General
0
(
D
jc�Inconsistent w/ Rules
Tier Level: ( II
III
Violation Location and Site Description
LaULong
Project Location: County
Shoreline Length. /
Street Address/ State Road/ Lot #(a) ,
SAM Not sure ves
Sandbags: Not Sure Yes
PNA: Yes
Adjacent
Subdivision
ORW: Yes No
Adjacent
City �
.ZIP./Ll
q
Crit. Hab. Yes No
Phone# Iu ).
River Basin
Photos ®yyyyyyyy''-0000---,,.,1
Adj. Wtr. Body
n /man
nkn
Waiver Required Yes
'
In DWQ Buffer Area Yes No
Closest Maj. Wtr. Body
Specify DWQ Buller R applicable:
NOV Date ✓ -\?- L
CNOV Date
Penalty Assessment
Sent to Respondent Date
Rcvd. by Dist. Mgr. Date
Assessment Extended Yes
RECEIVED
MAR 18 2014
Initial Req. Comp. Date q • 1i• 1'1
Date Comp. Observed
App./Permit Fee
Penally
WiIlfuUlntent.
No
Continuing
Extension Granted Yes No
Restoration Letter
Acceptance Date
7J.0409 Ref.
Recomm. Assess.
DCM Assess.
$
$
$
$
$
Is
Total
I
DCM-Mw CITY
Formal Assessments, Appeals and Reductions
Date Long Form Submitted - Assessment Appealed: Yes No
Date Formal CPA Submitted
Penalty modified
Final Assessment. $ Date
Attorney General's Office for Injunction or Formal Collection
Date sent to AG Respondent not responsive to penalty/NOV ❑ Injunction to complete restoration
Date Collection Letter Sent Date Demand Letter Sent
Violation Activities and Impacts
AECs Affected: Wetlands Impacted? Yes No If yes, which types:
CW EW PTA ES PTS OFA URA N/A SS SC SP IF BF 404 TY
PWS: FC: (� J
Other: � � /yjl
Restoration Required by the Respondent Yes No / Jtf�/�'
Dimensions in excess
of permit/ unauthorized activities
Dimensions to restore
Final
allow
Actually restored
Development Activities
Habitat Description
-
NOTES
Closing
Payment Received $ Date Date Case Closed
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
NOTICE OF VIOLATION
March 14, 2014
CERTIFIED MAIL 70110110 0000 9947 2437
RETURN RECEIPT REQUESTED
B & B Marine Construction, LLC RECB=
c/o Mr. Brandon Grimes
P.O. Box 2574
Surf City, NC 28445 MAR 18 2014
RE: VIOLATION(S) OF CAMA MAJOR DEVELOPMENT PERMIT NO. 62542D*
CAMA VIOLATION #14-03D DCMM'M MC f y
Dear Mr. Grimes
This letter is in reference to my February 14, 2014 site visit at property owned by Ms. Catherine Kelly
Topsail Sound located in Surf City located at 501 South Topsail Road, Pender County, North Caroline
of the onsite visit was to investigate unauthorized development on the aforementioned propertv
references the site visit conducted on January 28, 2014 and March 11, 2014 by Jason Dail, F
and your subsequent conversation regarding unauthorized development at this location.
Information gathered by me for the NC Division of Coastal Management indicates that tb
Construction, LLC as contractor for Ms. Catherine Kelly are in violation of the terms P,
Development Permit No. 62542D which was issued to B & B Marine Construction.'
Commission and the North Carolina Department of Environment and Natural W
immediately CEASE AND DESIST such violation(s) and comply with the tern
the terms and conditions of a permit are not complied with, the permit is P
On October 24, 2013, CAMA Major Development Permit No. 62542r
LLC on behalf of Ms. Kelly for of a pier and 400 sq. ft. platform ae
Pender County, North Carolina. This permit was issued for try'
Trust Areas, Areas of Environmental Concern (AEC), in as
113A-118.
This permit included the following terms and conditio,
1. All construction shall comply with 15A
For the following reasons, you are in violaL.
1. According to 15A NCAC 07H .1205(e):1
pier) allowed shall be 8 sq. ft. per linear fo,,
platform (400 sq. ft.). The 50 ft. shoreline ak
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: (910) 796-721S FAX: 910395-39641 Internet: www.nccoaslalmanaga
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled I10% Post Cons,
B & B Marine Construction, LLC
March 14, 2014
Page 2 of 2
additional unauthorized 5 ft. by 21 ft. platform (105 sq. ft.) was constructed creating 505 sq.
platform.
I request that you immediately CEASE AND DESIST any further development and contact me about this matter. A
civil assessment of up to $10,000 plus investigative costs may be assessed against any violator. Each day that the
development described in this Notice is continued or repeated may constitute a separate violation that is subject to
an additional assessment of $10,000. An injunction or criminal penalty may also be sought to enforce any violation in
accordance with N.C.G.S. 113A-1 26.
It is the policy of the Coastal Resources Commission to levy a civil assessment not to exceed $10,000 plus
investigative costs against all violations. This is done to recoup some of the costs of investigating violations and/or to
compensate the public for any damage to its natural resources. Whether a higher amount will be assessed depends
on several factors, including the nature and area of the resources that were affected and the extent of the damage to
them.
Based upon the North Carolina Administrative Code, Title 15A, Subchapter 7J.0409(g)(4)(E) the policy of the Coastal
Resources Commission is to levy a civil assessment against contractors in addition. to that assessed against the
landowner. Therefore, you should expect a civil assessment to be levied against you.
I request that you contact me immediately about these important matters. The relevant statutes and regulations are
available from this office, and I am willing to assist you in complying with the requirements of these laws. A site
inspection will be made in the immediate future to determine whether this REQUEST TO CEASE AND DESIST has
been complied with. Upon my submission of an enforcement report to the District Manager you will be notified as to
the amount of the civil assessment for failure to comply with the terms, conditions, or requiremen
Sint
Tara MacPherson
Coastal Management R se tative
Cc: Debra Wilson, District Manager, DCM
Roy Brownlow, Compliance Coordinator, DCM
Jason Dail, Field Representative/LPO
ENCLOSURE
REG
MAR 1
DC,v
127 Cardinal Drive Ext., Wilmington, North Carolina 284053845
Phone: (910) 796-72151 FAX: 910-39639641 Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper
i 1 � '�
1
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V.
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CDEEIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
NOTICE OF VIOLATION
March 14, 2014
CERTIFIED MAIL 70110110 0000 9947 2437
RETURN RECEIPT REQUESTED
B & B Marine Construction, LLC
c/o Mr. Brandon Grimes xECE1VED
P.O. Box 2574
Surf city, NC 28445 MAR 18
2014
RE: VIOLATION(S) OF CAMA MAJOR DEVELOPMENT PERMIT No. 62542D'
CAMA VIOLATION#14-03D DC:AM—IfDCITY
Dear Mr. Grimes:
This letter is in reference to my February 14, 2014 site visit at property owned by Ms. Catherine Kelly, adjacent to
Topsail Sound located in Surf City located at 501 South Topsail Road, Pander County, North Carolina. The purpose
of the onsite visit was to investigate unauthorized development on the aforementioned property. This letter also
references the site visit conducted on January 28, 2014 and March 11, 2014 by Jason Dail, Field Representative,
and yoursubsequent conversation regarding unauthorized development at this location.
Information gathered by me for the NC Division of Coastal Management indicates that the actions of B & B Marine
Construction, LLC as contractor for Ms. Catherine Kelly are in violation of the terms and conditions of CAMA Major
Development Permit No. 62542D which was issued to B & B Marine Construction, LLC by the Coastal Resources
Commission and the North Carolina Department of Environment and Natural Resources. I hereby request that you
immediately CEASE AND DESIST such violation(s) and comply with the terms and conditions of the above permit. If
the terms and conditions of a permit are not complied with, the permit is null and void from the date of its issuance.
On October 24, 2013, CAMA Major Development Permit No. 62542D was obtained by B & B Marine Construction,
LLC on behalf of Ms. Kelly for of a pier and 400 sq. ft. platform adjacent to Topsail Sound on property located in
Pender County, North Carolina. This permit was issued for major development in the Estuarine Waters and Public
Trust Areas, Areas of Environmental Concern (AEC), in accordance with North Carolina General Statutes (N.C.G.S.)
113A-118.
This permit included the following terms and conditions(s):
1. All construction shall comply with 15A NCAC 07H .1200.
For the following reasons, you are in violation of the above terms and conditions(s) of said permit:
1. According to 15A NCAC 07H .1205(e): The total square footage of shaded impact for docks (excluding the
pier) allowed shall be 8 sq. ft. per linear foot of shoreline. This permit was issued for a 20 ft. by 20 ft.
platform (400 sq. ft.). The 50 ft. shoreline allows for a maximum of 400 sq. ft. of shaded impact. An
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: (910) 796-72151 FAX: 910-395396411ntemst: www.nocoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled 110% Past Consumer Paper
B & B Marine Construction, LLC
March 14, 2014
Page 2 of 2
additional unauthorized 5 ft. by 21 ft. platform (105 sq. ft.) was constructed creating 505 sq. ft. of total
platform.
I request that you immediately CEASE AND DESIST any further development and contact me about this matter. A
civil assessment of up to $10,000 plus investigative costs may be assessed against any violator. Each day that the
development described in this Notice is continued or repeated may constitute a separate violation that is subject to
an additional assessment of $10,000. An injunction or criminal penalty may also besought to enforce any violation in
accordance with N.C.G.S.113A-126.
It is the policy of the Coastal Resources Commission to levy a civil assessment not to exceed $10,000 plus
investigative costs against all violations. This is done to recoup some of the costs of investigating violations and/or to
compensate the public for any damage to its natural resources. Whether a higher amount will be assessed depends
on several factors, including the nature and area of the resources that were affected and the extent of the damage to
them.
Based upon the North Carolina Administrative Code, Title 15A, Subchapter 7J.0409(g)(4)(E) the policy of the Coastal
Resources Commission is to levy a civil assessment against contractors in addition, to that assessed against the
landowner. Therefore, you should expect a civil assessment to be levied against you.
I request that you contact me immediately about these important matters. The relevant statutes and regulations are
available from this office, and I am willing to assist you in complying with the requirements of these laws. A site
inspection will be made in the immediate future to determine whether this REQUEST TO CEASE AND DESIST has
been complied with. Upon my submission of an enforcement report to the District Manager you will be notified as to
the amount of the civil assessment for failure to comply with the terms, conditions, or requirements of such permit.
Sind
Tara MacPherson
Coastal Management &se
Cc: Debra Wilson, District Manager, DCM
Roy Brownlow, Compliance Coordinator, DCM
Jason Dail, Field Representative/LPO
ENCLOSURE
rM
RECEIVEDAR 18 2014
DC-14-M.. D CITY
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: (910) 796-72151 FAX: 910-395-396411ntemet: www.n000astalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper
C/kr0(7C7 ❑ DtiE®CaE &FILL' ' ` M1
X.
:
ENERAL PERMIT
Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued "
As authorized by the State of North Carolina, Department of Environment and
Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC
/
Applicant Name`
�❑ les a3ached.
Project Location: County ; ! '
Address - `. _
Street Address/ State Road/ Lot #(s)
City;; —1'- — —State' `� ZIP'' 4-5-','%
�f 9 ✓�` d�tTJr',� �h'',rf.' .
Phone # (+' )_'. _ Fax # ( )
Subd' 'sion
Authorized Agent i
i / f r?f' / l'
G9G�
City '1 rr4 ZIP
_
o cw Ey >UPTA p.JEs ❑ PTS
Phone # (9�i� ) 5YV •-S 3 River Basin L ,Z
Affected
AEC(s): OEA ❑ HHF O IH ❑ URA ❑ N/A-
Adj. Wtr. Body �u - e' "•'' nat man unkn
ORW: P `
Hab.
�R '/
Closest Maj. Wtr. Body
yes no yes no \Crit yes km'
Type of Project/ Activity I^
Pier (clock) length to k576 AM
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I Agent or,J�)plicant Printed Name
Signature•'"Please read compliance statement onback ofpermit
( d�22->
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Issuing Date
Application Fee(s) Check# uGCalrl
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nature.
r ExpimOon Date
fiction Roverfile Name -