HB_04-062_Jeffs

Jun 09 04 02:23p Peter W Jeffs, Ph-D 919-929-9343 P.2
Jun 09 04 01:05P TOWN OF HOLDEN BEACH 9100429315 P•2
TOWN OF HOLDEN
BEACH
Loral Government
CAMA
MINOR DEVELOPMENT
PERMIT
as authorised W the Slay d North Carolina, Ipeptd rsv:arerarm.
and Rah"R.oa and Um CeasWtlesan Caamitmoatardevdopment
in an arvo of aaviranmeun �� Stiabaesv �ll� -ilk
HB 2004-062.�s(c
Permit Nu
0
" 'O &Ov"
Issued Peter and Christina Jeffs , authorizing developmem_in Esturanne Shoreline at864 Heron Landing
Wynd, as requested in the perminee's application, submitted May 4, 2004 This perem14 issued on June 9,
20D4. is subject to compliance with the application and site drawing twhere consistent with the permit), all
applicable regulations and special conditions and notes set forth below- Any violation of these terms may
subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
PERMTTTOA INSTALL SEPTIC SYSTEM CONS7RUCTSINGLE FAMILY RESIDENCE. GRAVEL ORIVER;t Y. AND
RETENTION AREAS
A COASTAL WE77.ANAS LINE MUST BE STAKED Or LOCAL PERMIT OFFICER AND THE U S ARMY CORPS OF
ENGINEERSMUST DETERMLNE T11F 404 JURISDICTION PRIOR TO ALL CONSTRUCTION OR PERMITS BEING
ISSUED-
1- Pnw rn initiating my land-d.ttvbing activities adegerate sedimentaioW✓ mion control merinos must be employed
to prevent the nnovtlnCrt of mconsolidated materials imo the marsh or water. -ib= aarasurs must remain in place until
such time as the area is pmPerly stabilkwd with vegetated cover.
2. Any change or ehamges in the plans for development, construction or Ind use activities will require a re�luatiml
and modification of this permit
3_ All consdMCOon must conform to the jalcmatirma: Building Code requirements and all Odra LOCaL Stale and
Frdetal regulations.
4. All pmposed development and associated construction rust be done in accordance with the permitted workplat
drawing (s) that were submAted on June 02, 2004 n n f, _ nl n /t
This pent xbon may be appealed by IV pe"bte a other
gatast omon, "g 1 rangy M) days d the issdng daAe. Fwm
the date of w WPM. airy' work candoded under hS PUW must
maseum the appeal. resd+ffi
This prom must be oft the pmiW sne aW amgside to the pelmil
Wt when the P4n=i is rspecled IN mrnpliara e
Any uueiiterarloe wwk or pmjed mo6ficalun mat atrered uhda
this perm:. require 1~ Writer. Pe" app-M
All conk muss cease when Its Pe"ut WP res rrh oweMk a 31.
2007
W. lI Penns 3 is agreed mat Ins project is mns"stent wilt
the lot land else Plan and all applicable wdnances.
This prune may m be har6t9red m a Mnef party Irmma the
,dnen appmval oltee Oivhion of Coastal Maeaagerrent.
Local Fermi Unva 15F.
RnOm DA PHILLPS
CAMA Loral Pem ; Olri ad
t.
Isignatenre n4pved l omdihnns above apply le pomp

Jun 09 04 02:23p Peter W Jeffs, Ph-D 919-929-9343 p.3
Jun 09 04 01:05p TOWN OF HOLDEN BERCH 9108429315 p•3
Name # HS 2004-062
Peter & Christina Jeffs
Page Two
S. pursuant to 15 NCAC, Subchapter 71 .0406 (h), this Permit may not be assigned, transferred, sold or otherwise
disposed of to a durd party-
& Marsh and wetlands shall be thou areas so designated by CAMA and the US. Army Corps Of Eug seem and shown
on plat used for the project- Also plat most include the cenifnstmn which states the plat accurately depicts the boundary
of the 404 line and most be signed by the Corps of Engineer mpitsemative. structure shall not be
7. Town Orditnnte M-027_ on lots containing marsh or wetlands the piles supporting
the located closer than seven (7) feet foam an existing bu6dne3d, the COE Inn . or CAMA line, whichever is doser.
B Town Ordinance 157.027: Fill material placed landward of the marsh Ime is not allowed to slip or wash into the
ms5b.
9. No fill material is to be placed in federal or coastal wetlands Temporary Temporastorage of manuals or mil in wetlands is
strictly prohibited.
10. The proposed construction shall meet all requirements of section 159.00 and 157.060 located in the Cade of
Ordmaocs
II. Tne iroovative stoamw&mr system authorzed with this permit must be maintained for the life of the structure
addressed.
M It is noted that coastal marsh exists on the property, and that the proposed development addressed on the submitted
plat dated is not located within the marsh.
13. 1t is noted thist there are federal wetlands on this properly, as delineated by 7sh wo on the phi dated lure 02. 2004
and is not located within these wetlands.
I4. No excavation or filling of any wetlands or waters is authorized under the Permit
IS. A COM of this pewit stall be available oosite for regulamry inspection.
16. The stem mm shall be set back a minimum of 60 feet from the fast 0m of stable natural vegetation. as determined by
the DOM or the L.PO.
This paint wia n may be appealed M the pedmitlee a other
qualified Persons wdhin twenty (M) days of the issuing bale. From
the dais d M appeal. any mark Conducted utalc des Perm must
®temp, the appeal is msd+af
This Penn) most ba Pin the Pitied site go amesde to the Pam"
drwwhen be poled s ispeCedim m illib ce.
Any tmminaPre von, m poled modilicaan not covered udm
Oct pest napu[e 4utberhw4fecn Pad apptoval
At work rM6t cNESSewhah /hs Mond ecpiesan Decen6er17,
20D7
In"cis paroft it is speed tat ins poled is consistent vim
the wml Lad Use pan ad s appiredeamfi s
This psmil may not be tanskavd 1n ado FOV wined ne
wMen appm A d he 0o shin of Coastal Natagment.
omwa Plus
CANA Local PPtma 01hGol
�1-
if abmealt:

' Jun 09 04 02:23p Peter W Jeffs, Ph.D
Jun 09 04 01:05F TOWN OF HOLDEN BERCH
919-929-9343 p.4
9109429315 p-4
Name Peter&Christina Jeffs
Minor Permit #HB 2004-62
Page Three
�10
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N F ENS
CONS
"CP� M
17. Pursuant to 15A NCAC 073 .0406(b), this permit may not be assigned, transferred, sold or
otherwise disposed of to a third party by the applicant, agent, or any entity other than the NC
Division of Coastal Managemerit.
I& ALL CONSTRUCTION AND FILL MUST BE INSTALLED IN ACCORDANCE WITH
SECTION 158.00 OF THE TOWN OF HOLDEN BEACH CODE OF ORDINANCE-
19. Please be advised that nothing including gutters, everhangs, rvoflmes, stops, shall be
cantilevered over the coastal wetland line or constructed over the coastal wetland fine-
20. The concrete slab will be a finished elevationll 6e 0reluxated or dismantled when it becomes
21. Any stricture authorized by this permit
imminently threatened by changes in shoreline configuration- The structure(s) shall be relocated or
dismantled within two (2) years of the time when it becomes imminently threatened, and in any case,
upon its collapse or subsidence. However, if natural shoreline recovery or beach renourishment takes
place within two (2) years of the time the structure becomes imminently threatened, so that the
structure in no longer imminrnity threatened, then it need not be relocated or dismantled at that time.
This condition shall not affect the permit holder's right to seek authorization of temporary protective
measures allowed by CRC Rules.
23-Such enclosed space is to be used solely for storage and by signing this permit
you
as the owner understand that this area shall not be used for human habitation.
26. Flood vents shall he installed in accordance with FEMA regulations-
26.
This pmi wam nay he appeabd M be venritlee IN OINK
4Aded P sms wrilin twesq Sm1 days d be snwg cat From
Me doe of an appeal. ary WM aaNcurd under d- Perms rwst
cease Loa ere appeal is meted.
TIE Pend moot at on dre pmied silo and aaessWe to de pemnt
otimwhen the Rolect is raccMd fKeongiarte.
Any Wa 10nu¢ wok K FuRQ n rat a—ed under
INs peawl, re7RN11"WOKr Pe"od appmrd.
Al wale must aeon when thspatinit eMnM on D—Ober at,
2007
b swig tMs W" 9 s w- Kra eE p vpa iscon wOud wln
fie bed lad Use Plan and at awk2Me oErrars.
Ths pfflM may ro be baslmed to aWftK pony WOW Ore
,Men appmM dthe pMIW d Coasbl 11ftra90171em.
Glyn local Perri[ ottria
=11ueRT?b1e-edemrrdliKs ahmeappybpKm -

Jun 09 04 02:23p Peter W Jeffs, Ph.D 919-929-9343 P.5
Jun 09 04 01:05p TOWN OF HOLDEN BERCH 9108429315 P•5
AEC HAZARD NOTICE
Project Is In An I EtodiVlI' � �Ie�I lord Area _Inlet Hazard Area
Date tot Was Platted:
This notice is untended to make you, the applicant, aware
of the special risks and conditions associated with
development in this area, which is subject to natural
hazards such as storms, erosion and currents The rules of
the Coastal Resources Commission require that you
receive an AEC Hazard Notice and acknowledge that
notice in writing before a permit for development can be
issued.
TMCommissiorisrule imbuildingsu lards,oceanfront
setbacksand dunealterationaredeigned to+mtnimm but
not eliminate, property loss from haraards. By granting
permits, the Coastal Resources Commission does not
guarantee the safety of the development and assumes no
liability for future damage to the development
The best available information, as accepted by the Coastal
Resources Commission, indicate that the annual ocean
erosion rate for the area where your property is located is
feet per year.
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studies also indicate that the shoreline could move as
much as Meet landward in a major storm -
lhmejloodwaters inamajor sto marepredidedtobeabout
1— feet deep in this area.
Preferred oceanfront protection measure are beach
nourishment and relocation of threatened structures.
Hard erosion control structures such as bulkheads,
seawalls, revetments, groins, jetties and breakwaters are
prohibited. Temporary devices, including sand bags, may
be allowed under certain conditions.
This structure shall be relocated or dismantled within two
years of becoming imminently threatened.
The applicant must acknowledge this information and
requirements by signing this notice in the below space.
Without the proper signature, the application will not be
co}nplete.
SPECIAL NOTE: This hazard notice is requited for
development in areas subject to sudden and massive
stmmsanderosion_ Permttsissued fordevebpmartinthis
area etpireonDecember 31 of the third year following the
year in which the pernnitwas issued. Shortly before work
begins on the project site, the Local Permit Officer will
determine the vegetatumlineand setback distanceatyour
sitelfthepropertybasseenlittlechangeand theproposed
development can still meet the setback requirement, the
LPOwill inform you thatyyou mayybegtn work.Itis impor-
tantthatyoucheckwith9:LPObefoxe thepamitexpires
foroffipal approval to continue the work after the peanut
has Generally, if foundation pilings have been
placed and substantial progress is continuing, permit
renewal may not be necessary. If substantial progress has
riot been made, the p�m-1 must be renewed and a new
setback lineestablished. It is unlawful to continue work
after permit expiration without this approval.
For more information, contact:
Phone
i
Revised 11193

4o04- o to 2
STATE OF NORTH CAROLINA
TOWN OF HOLDEN BEACWUNTY OF BRUNSWICK
110 ROTHSCHILD STREET
HOLDEN BEACH, NC 28402
AFFIDAVIT OF PUBLICATION
LAMA PERl141T NOTICEBefore the undersigned, a Notary Public of said County and State,
Pursuant to NCGs 113A4119(b), the duly commissioned, qualified, and authorized by law to administe
municipality of Town of Holden Beach, a oaths, personally appeared q(�
locality authorized to issue CAMA per. \�,►Y�'
cuts in the areas of environmental con- 4
R. cern, hereby gives NOTICE that on May 3, Scott RHarrell tipo�
2004, applicant Peter and Christina Jeffs,
applied for a LAMA minor development who, being fast dal sworn, deposes and says: that he
permit to idea grade,, construct a single g Y P Y
family residence at 864 Heron landing
wynd.
The application may be inspected at the Publisher P
below address. Public comments received
by May 14, 2004, will be considered. Later (Owner, partner, publisher, or other officer or employee
comments will be accepted and consider. authorized to make this affidavit) O
ed up to the time of permit decision. ti
Project modifications may occur based on
further review and comments. Notice of of The Brunswick Beacon, a newspaper published, issued, and entered
the permit decision in this matter win be provided upon written request as periodical mail in the Town of Shallotte in the said County and
Rhondaahillips State; that he is authorized to make this affidavit and sworn statement;
Local CAMA Permit officer that the notice or other legal advertisement, a true copy of which is at-
uO Rothschild Street
Holden Beach, NC 28462 8462. tached hereto, was published in The Brunswick Beacon on the follow-
[phone] ing date(s):
May 6
May 6, 2004
and that the said newspaper in which such notice, paper document or
legal advertisement was published, was at the time of each and every
such publication, a newspaper meeting all the requirements and quali-
fications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of
the General Statutes of North Carolina.
This the 6th day of May, 2004.
(Signature of person making affidavit)
Sworn to and subscribed before me this 6th day of May,
% AY
NQ1ARkN'
s
AUG r2�(Notary Public) ..
iCK COVr; .My commission expires: December 29, 2W4.
TOWN OF HOLDEN BEACH
110 ROTHSCHILD STREET
HOLDEN BEACH, NC 28402

Locality Io LCI `J 74L� ICIGYI ,L �e /; cam^ Permit Number r ZG 0 --J - O Co Z
GENERAL INFORMATION
LAND OWNER
Name Peter and Christina Jeffs
Lll,'2 200 Red Bug Lane
City
Chapel Hill
n'._
13381S (1IIHDSN
HCV79 N30,0s?
State NC zip 27514
AUTHORIZED AGENT
Name Coastal Development & Realty Builders, Inc.
Address 131 Ocean Blvd. West
City Holden Beach
Phone [phone]
State NC zip 28462 Pie [phone]
LOCATION OF PROJECT 864 Hercin Landing Wynd
L4 13 r.5u bd;V,Si nn: Heron Landing North
of not oceanfront, is waterbody natural or manmade?) w A16 R WA j
DESCRIPTION OF PROJECT Fill and Grade l-ot;Construction of 4 Bedroom, 4 112 Bathroom
single family residence;
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application)
Ocean Hazard _ Estuarine Shoreline _ORW Shoreline
PROPOSED USE
X Residential _ Commercial/Industrial _ Other _ MAY 17 2004
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER POPERVI� N � E M E n'
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the 05
of an ORW shoreline)
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING 2,963.25 (Heated)
SQUARE FOOTAGE OF SITE 11.389.55
OTHER PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the CAMA minor
development permit As a service we have
compiled a listing of the kinds of permits that
might be required. We suggest you check
over the list with your LPO to determine if
any of these apply to your project
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
Burning Electrical, Plumbing, Heating and
Air Conditioning, Insulation and Energy
Conservation, FIA Certification, Sand Dime,
Sediment Control, Subdivision Approval,
Mobile Home Park Approval, Highway
Connection, and others.
DECEE WE
MAY - 4 2004 D
TOWN OF HOLDEN BEACH

I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an AEC or a n authorized to act as an agent for purposes of applying for a CAMA minor development
permit, certify person
the person listed as landowner on this application has a significant interest in the real
property described therein. This interest can be described as: (check one)
_X an owner or record title, Title is vested in Peter and Christina Jeffs see Deed gook 1928
page1133 in the Brunswick County Registry o
_ an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
_ if other interest such as written contact or lease, explain below or use a separate sheet and attach to this
application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit
(Name) (Address)
(1) Joel & Hope Panara 1059 Grayson Farm Rd. Creedmore, NC 27522
(2) Douglas Duncan 3589 Classic Dr. South Memphis, Tenn. 38125
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I admowledge that the local permit officer has explained to me the
particular hazard problems associated with this lot This explanation was accompanied by recommendations
concerning stabilization and floodprooFmg techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permitapplicatioa
This application includes: general information (this form), a site drawing as described on the back of this ap-
p&mtion, the owmeshfp statement, the AEC hazard notice where necessary, a check for $50.00 made payable to
the locality, and any information as may be provided orally by the applicant. The details of the application as
described by these sources are incorporated without reference in any permit which may be issued. Deviation
from these details will constitute a violation of any permit Any person develop an AEC without a per-
mit is subject to civil, criminal and administrative action
This the 3rd day of May 2004 pT 3
owner or person au t
purposes of filing a CAMA apbibn
DIVISION OF
COASTAL MANAGEMENT

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63/16/2984 15:10 B424004 FRDEV114C PAGE 04
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r Prhw b leswnc�e a ttw operation Permit
Inc ayttem shall be completed. Installed. sea leaned In nce with the approved da"n, hdudFng groper
abandonment of tanks existing wells, and other components,
final landscaping, water diversion devices&, and vegetative cover requirements and pressure adjustment shall be
completed,
- the engineer or applicable responsible partles shall Submit a64)uht plats to the BCHD, the plans shall reflect any
changes or Ntarasons from the as -approved plans.
3. For systema that have been enghreared, ma design engineer shall cefft In Ong to the Brunswick County Health
Department, that he has Inspected the Installation and that it has been installed according to the approved plans and
specifications.
Any necessary easements, plats, or documents shall no recorded with the Regleter of Deeds and copies submitted
to #a BCHD.
• The owner and n Public Management EndtylSubsurfaoe System Certified Operator shall execute a contract which
addresses all of the requlnments for maintenance, monitoring, and reporting in Sectlen .1g61 end 6u
requirements of the Schedule of Operation and Maintenance to be apart of the Operetlon Permit for the faoilky.
ProNsiorha of Mid contract shall be in effect for as long as the system Is In use.
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ANNOWATM TO OONBTRUM" THIS - � DAY
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Present for conference(list)-
Pre -construction conference for construction of system
by: Date:
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1'V` 0IV1S10N OF NI
COASTAL MANAGEME
POMIL of
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pj D 902 Mrnket St. CONSULTING ENGINEERS, INC. WBrrvngton. N.C. 2WICheck Job JyjjjfM�/g/E� For G
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MAY 17 2004
DIVISION OF
COASTAL MANAGEMENT

Action Id. 200400573
U.S. ARMY CORPS OF ENGINEERS
WILNIINGTON DISTRICT
County: Brunswick U.S.G.S. Quad: Holden Beach
NOTIFICATION OF JURISDICTIONAL DETERNIINATION
Property Owner/Agent: Peter and Christina Jeffs
Address: 200 Redbud LN
Chapel Hill, NC 27514
Telephone No.: _
Size and location of property (waterbody, road name/number, town, etc.) The site is lot 13, a vacant parcel on Heron
Landing Wvnd Holden Beach Brunswick County, NC. Latitude: 33.9128"N; Longitude: 78.3314° W.
Indicate Which of the FollowinE Apply:
Based on preliminary information, there may be wetlands on the above described property. We strongly suggest you have
this property inspected to determine the extent of Department of the Army (DA) jurisdiction. To be considered final, a
jurisdictional determination must be verified by the Corps.
X There are wetlands on the above described property subject to the permit requirements of Section 404 of the Clean Water
Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations, this determination may be
relied upon for a period not to exceed five years from the date of this notification.
_ We strongly suggest you have the wetlands on your property delineated. Due to the size of your property and/or our
present workload, the Corps may not be able to accomplish this wetland delineation in a timely manner. For a more timely
delineation, you may wish to obtain a consultant. To be considered final, any delineation must be verified by the Corps.
The wetland on your property have been delineated and the delineation has been verified by the Corps. We strongly
suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the Corps.
Once verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your property
which, provided there is no change in the law or our published regulations, may be relied upon for a period not to exceed
five years.
X The wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the Corps
Regulatory Official identified below on 4130/2004. Unless there is a change in the law or ourpublished regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
_ There are no waters of the U.S., to include wetlands, present on the above described property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
_ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Washington, NC, at (252) 94610 to determine
their requirements. ft'P R �� ��
Remarks:
Corps Regulatory Official:
Date 04/3012004 Expiration Date 04/30/2 Q\v P PG�ME
P ,ON P� Page l of 2

Action Id. 200400573
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this
determination and/or the Corps regulatory program, please contact Thomas Farrell at 910.251.4466.
Basis For Determination: The site contains salt marsh wetlands that are adjacent and hvdroloeically connected to the
Intracoastal Waterway, a desi nated water of the U.S.
Corps Regulatory Official (Initia
FOR OFFICE USE ONLY:
• A plat or sketch of the property and the wetland data form must be attached to the file copy of this form
• A copy of the `Notification Of Administrative Appeal Options And Process And Request For Appeal" form must be
transmitted with the property owner/agent copy of this form
• If the property contains isolated wetlands/waters, please indicate in "Remarks" section and attach the "Isolated
Determination Information Sheet" to the file copy of this form
Page 2 of 2
11�4�, MAylll.11111i11 �4
Mp�,NAGEMEn:"
GOp,S�A`

NOTIFICATION OF ADIITNISTRATWE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant Peter and Christina Jeffs File Number: 200400573
Date: Aril 30, 2004
Attached is:
See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of emussion)
B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision. Additional
information may be found at httl)://www.usace.arrnv.mil/inet/functions/cw/cecwo/reg or
Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that the
permit be modified accordingly. You must complete Section II of this form and return the form to the district engineer. Your
objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right to appeal
the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a) modify the
permit to address all of your concerns, (b) modify the permit to address some of your objections, or (c) not modify the permit
having determined that the permit should be issued as previously written. After evaluating your objections, the district engineer
will send you a proffered permit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If youieceived a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and condibam therein, you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by ce io of this form
and sending the form to the division engineer. This form must be received by the divis' W✓in ,the date of
1�
this notice.nm
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of E ers Admini tipeal as by
completing Section 11 of this form and sending the form to the division engineer. mu r ved by the division engineer
within 60 days of the date of this notice. ON OF F sl
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeaMe appr inforation.
information.
T
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure tsthe Corps within 60 days of the date of
this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section D of this form and sending the form to the division engineer. This form must be received by
the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the preliminary M.
The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed), by contacting the Corps
district for further instruction. Also you may provide new information for further consideration by the Corps to reevaluate the JD.
SECTION 11 - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT

REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the record
of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to clarify the
administrative record. Neither the appellant nor the Corps may add new information or analyses to the record. However, you may
provide additional information to clarify the location of information that is already in the administrative record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may also
appeal process you may contact:
contact:
Mr. Arthur Middleton, Administrative Appeal Review Officer
CESAD-ET-CO-R
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room 9M15
Atlanta, Georgia 30303-8801
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government consultants,
to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day notice of any site
investigation, and will have the opportunity to participate in all site investigations.
Date:
Telephone number:
Signature of appellant or agent.
DIVISION ENGINEER:
Commander
U.S. Army Engineer Division, South Atlantic
60 Forsyth Street, Room 9M15
Atlanta, Georgia 30303-3490
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