HomeMy WebLinkAbout68-23 L&R Haven LLCTown of North Topsail scach
Issued by DCM
68-23
Permlt Number
LAMA
MINOR DEVELOPMENT i
�
PE rr"i li"
as authorized by the State of North Carolina, Department of Environmental Quality and
the Coastal Resources Commission for development In an area of environment concern
pursuant to Section 113A-118 of the General Statutes, "Coastal Area Management"
Issued to L d R haven, LLC., authorizing development in the Estuarine Shuraline - ORW (AEC) at 2 Sailview Drive, in
North Topsail Beach, Onslow County, as requested in the permiltee's application, received on May 11, 2023. This
permit, issued on May 22, 2023, is subject to compliance with the application and site drawing (where 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.
This permit authorizes: Construct 3,397 SF house with 1,680 SF concrete driveway,
(i) All proposed development and associated construction must be done in accordance Will the permitted drawings DCM-
MHC May 11, 2023, Weston Lyall R1 12114122.
(2) All construction must conform to the N.C. Building Code requirements and all other local. State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at 262-725.3908 for a final inspection at
completion of work.
(Additional permit Conditions on Page 2)
This permit action may be appealed by the permutes or other qualited persons
within twenty (20) days of the Issong date. From the date of an appeal, any
work conducted under this parmit must cease until the appeal is resol•rad This
permit must be on the project site and accessible to the permit officer when the
project Is Irespected for compliance. Any maintenance work or project
modfica ton not covered under this permit, require further written permit
approval. Ail work must cease when this permit expires on:
DECEMBER 31, 2026
In issuing Ibis perm II is agreed that this project Is consistent with ilia local Land
Use Plan and all aripheable ordnances. This parmil may not be transferred to
another party without the wTiden approval of the Division of Coastal
klanagemeni.
Tina Martin
NC Division of Coastal Management
400 Commerce Ave
paphead City, N 26557
P�RMITTEE or Authorized Agent
(Signature required it conditions above apply to permit)
Nam-.: L v R Haven, LLC
Minor Permll # 68.23
Date: May 22, 2023
Page 2
(5) The amount of Impervious surface shall not exceed 25% of the lot area within 575 feet of normal high water level
(Estuarine Shoreline • OP.W Area of Environmental Concern).
(6) Unless specifically allowed In 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feel landward of normal high water level. No portion of the
roof overhang shall encroach into the 30 8. buffer.
(7) All development shall provide for a buffer zone along the margin of the Estuarine Water which is sufficient to confine
visible sillailon within 25 percent of the buffer zone nearest the land disturbing development.
(8) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filler cloth must be
Installed between the land disturbing activity and the adjacent marsh or water areas, unfit such time as the area has been
properly stabilized with a vegetative cover,
(9) Any proposed for grading within the 30' buffer from the normal high water level must be contoured to prevent additional
stormwalei runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must remain In a
vegetated stale.
(10) All graded and filled slopes shall be of a sufficient angle to retain a vegetative cover or other erosion control device or
structure.
(11) This permit does not authorize development within any wetlands or open water areas.
(12) Prior to any development, the permiltee is required to contact the DCM Field Representative at 252-725.3908, to mark
the landward edge of the 30 ft. buffer.
(13) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction completion.
(14) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold, or otherwise
disposed of to a Third -party,
(15) The Permittee and/or the Permittee's Authorized Agent shall be responsible for obtaining any and all necessary
authorizations, approvals, or zoning and building permits from the local government having jurisdiction (Town
of North Topsail Beach and/or Onslow County) prior to commencing work.
SIGNATURE: l,L4y 1�.11Q1,ez DATE: � � 12
,
ERMITTEE or AUTHORIZ 0 AGENT
MINOR PERMIT TRACKING SHEET
APPLICANT:
AGENT:
Project Location
c�\�JlelJ kit ��
COMMUNICATION LOG
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
.'
Guc
V <1 7e
we.n n
'O � c t
a c uc 1
u o c 3 ��t 4�
e..Ribl-
a
a, � �`o� W y f,, `i 3 G � i s � 2 � 3pp 3•Es � Y E C,..E 3�
Tc 2 U W$W o a c s� o ', 's. E � ,}��I 7 �• ° q'o .c `� 3 �, = o
k °�� :. 4 c � aY G � Q c ��t_ •G. � � '°�' yJ � � " '�na•
0
Ln
5
>
;
S.
5a
3
y
� U
G C •''J+
L•
Gg
9
qv
Lrl
G
a
z 3
o
OIa
�v
,I�
F.
O p
�
•j d3�
�
OeB,
H y
<= r
a
g
3
s
t
At
o
< _•9
A
y
} C
c
c
NC Division of Coastal Management
Cashier's Official Receipt
Received From:' �n)��
-1 \
Permit No.: L D
Applicant's Name: `ln1/l'✓l / ��
Project Address:
26557 A Bcb
Date: bC�4 t \ 207-3—
Check No.: IsIq
County: 0y)ZIJ
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
f
Signature of Field Representative: inC4
IWp }' f ��IJ
Date:
Date: ,57w 23
7022 1670 0001 5834 8840
7022 1670 0001 5834 8833
M
n
n
WESTCO L A
Structural & Clvit Engineering land Surveying Serving Eastern North Carolina
STRUCTURAL ENGINEERING
CIVIL ENGINEERING
LAND SURVEYING
214 Highway 17 N. Suite l
Holly Ridge, NC 28445
910-329-9961 Office
Firm License # P-0937 www.WestonLyall.net
May 4, 2023
To: North Carolina Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Subject: 2 Sailview Dr, North Topsail Beach, NC 28460
The purpose of this letter is to notify the North Carolina Division of Coastal Management of
the proposed two-story residence on piles to be located at 2 Sailview Dr. (PIN#
428705185215), North Topsail Beach, Onslow County. The property owner is L & R Haven,
LLC Attn: Ron Malanga and contractor is Michael Howington who can be contacted at 917-
796-4425. Please see the enclosed CAMA Minor Permit Application as well as the
preliminary plot plan for the proposed dimensions and location of the project.
Thank you,
Weston Lyall, PE, PLS, PLLC
RFCF:IVi;7D
MAY 112p7
OOM'MHD City
Pile Plans, Foundation Designs, Structural Designs, Structural Analysis,
Stormwater Designs, Commercial and Residential Properties
Subdivision Designs, Land Surveys, Plot Plans, Elevation Certificates
All Your Engineering and Surveying Needs
Licensed Engineer in NC, SC, VA, AL, MS
Licensed Land Surveyor in NC
AGENT AUTHORIZATION FOR CAMA PERMIT APPLIGATIO
Name of Property Owner Requesting Permit � il€�v�k�
Mailing Address: Ca oXVIUN'Y1 NYC
Phone Number: • `�iu '4• 2:4t 4
Email Address:
I certify that I have authorized
ue69Corntrector
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
at my property located at - 'Wl i 1?t, Alta" tl tt Y7 % +
in t `)lItA County.
1 furthermore certify that i am authorized to grant, and do in fact ,grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to entor
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner info tlon:
4
�}
Signature
F) )Yu)
c
Print or type Name
Data
This certification is valid through y' l 1 ;
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Policy Number:
L & R HAVEN LLC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
2 SAILVIEW DRIVE
City State ZIP Code
NORTH TOPSAIL BEACH North Carolina 28460
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PIN # 428705185215
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat.34-30-9.0 Long.-77-23-54.07 Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 6
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 2437.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 13
c) Total net area of flood openings in A8.b 2600.00 sq in
d) Engineered flood openings? Z Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade RECE IVIFC)
c) Total net area of flood openings in A9.b sq in
MAY 11 202i
d) Engineered flood openings? ❑ Yes ❑ No
DGWI IIHO +.ITT
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
83, Slate
Town of North Topsail Beach 370466
Onslow
North Carolina
B4. Map/Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
88. Flood
B9. Base Flood Elevation(s)
Number
Date
Effective/
Zone(s)
(Zone AO, use Base Flood Depth)
Revised Date
3720428700
K
06-02-2021
06-19-2020
AE
12.0
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 x❑ NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑x Yes ❑ No
Designation Date: 10-01-1983 ❑x CBRS ❑ OPA
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6
ELEVATION GERTIFLCATE
OMB No. 1660-0008
Expiration Date: November 30. 2022
IMPORTANT: In these spades, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
2 SAILVIEWDAIVE'
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑x Construction Drawings" ❑ Building Under Construction" ❑ Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH; A (with BFE), VE, V1-V30, V (with BFE), AR, ARM, AR/AE, AR/A7-A30, AR/AH, ARIAO.
Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: N/A Vertical Datum: Geoid 12B VRS RTK GPS s
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measur4hientused.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.0 ❑x feet' ❑ meters
b) Top of the next higher floor 19.6 0 feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) 1,7.0 Z feet ❑ meters
d) Attached garage (top of slab) N/A ❑ feet ❑ meters ,
a) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) 14.1 0 feet ❑ meters
f) Lowest adjacent (finished) grade next to building (LAG) - 4.8 [X] feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6.0 0 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support ❑ feet - ❑ meters,
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION r
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law tacertify elevation information.
i certify that the information on this Certificate represents my best efforts to interpret the data available. i understand that any false
staternant may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided b a licensed land surveyor? Z Yes " 9 p y y ❑ No ❑Check here if attachments.
Certifier's Name License Number
Weston Lyall L-4438
_ RECEIIIGD��µti
eun � fn
pttHOlt.,
'1 µAR
Title
Owner/PLS
,l00!
Company Name—wiml I I cutj
Weston Lyall, PE, PLS, PLLC
.
: He
4,ttN L.(� ���
Address
214 Highway 17 N. Suite 1
City State ZIP Cade
Holly Ridge North Carolina 28445
trrfit 0* <
Signature Date Telephone Ext.
' 12-09-2022 (910) 329-9961
Copy all pages of this tlevatiorCertificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
This elevation 1s preliminary only for a proposed residence. Elevations noted are per construction drawings.
Section A8: Is the estimated enclosure area determined from construction drawings. Final calculations are determined with the finished
construction. Assumed engineered flood openings accommodating 200 SF of area per vent. Per engineered drawings, all ground floor
walls shall be constructed as break -away
Section C2 e: The proposed elevation of the wood stand for the A/C Unit. Final calculation to be determined with finished construction.
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No,
Policy Number:
2 SAILVIEW DRIVE
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement,
crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions),
the next higher floor (elevation C2.b in
the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F —PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or
community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
MAY1�1>?2
❑ Check here if attachments.
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
2 SAILVIEW DRIVE
City Slate ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement
used in Items G8—G10, In Puerto Rico only, enter meters.
G1, ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Comments area below.)
G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE)
or Zone AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) E] feet E] meters Datum
of the building:
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
2 SAILVIEW DRIVE
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building
photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View" and 'Rear View";
and, if required, 'Right Side View" and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use
the Continuation Page,
Photo One
Photo One
Photo One Caption
Clear Photo one
NAY
00WA
Photo Two
NG
Photo Two
Photo Two Caption
-3m
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No,
Policy Number:
2 SAILVIEW DRIVE
City State ZIP Code
Company NAIC Number
NORTH TOPSAIL BEACH North Carolina 28460
If submitting more photographs than will fit on the preceding page, affix the additional photographs
below. Identify all photographs
with: date taken; "Front View" and 'Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
Photo Three
Photo Three
Photo Three Caption1a
I�EC�lutrf�
Photo Four
MAY i l ?�13
Photo Four
Photo Four Caption
FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 6 of 6
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
(xM �) V h lVs LLC
NIamee�off Adjacent Riparian Property Owner
Address' e_--�
a x�) NC 2 U
City. State Zip
To Whom It May Concern:
5-4- 2a23
Date
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
on my property at i sc�tivlel (�t� Irt�
in d NIOW County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME, OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMHFR), or by email at: (LPO EMAIL).
Sincerely.
�m fta%z
Property Owner's Name
Address
cin, -7co4.442..S
Telephone Number
City State Zip
I have no objection to the project described in this correspondence. dFCFIVED
I have objection(s) to the project described in this correspondence.
MAY I1 2023
Adjacent Riparian Signature Date OCM-MHD CITY
Print or Type Name Telephone Number
Address City State Zip
Revised July 2021
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (I
OR PERMIT)
,btw v! ri rt �4 '
Name of Adjacent Riparian Property Owner
Address
irwam
Citv, State Zip
Date
To Whom It May Concern:
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
on my property at V I11 1 11 .' x - -
in C {_Y-, lON County, which is adjacent to your property. A copy of the application and project
drawing is attachedJenclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments arc received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMBER), or by email at: (LPO EMAIL).
Sincerely,
Property Owner's Name
Address
City
u'AWTAU,UC �M�ke uwtnq Toni Telephone Number
State
I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Adjacent Riparian Signature
Print or Type Name
Zip
Rl c,'EFI / t)
MAY 11 M3
0CM-A4HD CITY
Date
Telephone Number
Address City Stare Zip
Revised July 2021