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HomeMy WebLinkAbout89053A - Dopler, Bruce, Alderson, GinaOccurv,��CAMA ❑ DREDGE & FILL V I'.i N9 ).` ' � B C D � � ) I GENERAL PERMIT Previous permit Date previous permit issued ip—N ❑Modification []Complete Reissue ❑ Partial Reissue 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 SA NCAC -TI .2 e o ❑ Rules attached. 01---aal Permit Rules available at the following link: www.deq.ncgov/CAMArules Applicant Name / Uo [,r yt Authorized Agent N h I E %� is ^ i n � Address C w./1 f� 4- 1 Project Location (County):r� T r — City Q.a- Stare 4, Zip 1 {q 9 % 3 Street Address/State Road/Lot#(s) IQ, % G(..c, (, Ly. .✓ .« i�. ^�', Phone #73Q%) I ZitnSubdivision L a S JS Email 0 � _G .'L C,y city C /;'—I ... ZIP Affected ❑LW BtW 4�irp'X DES ❑pTS Adj. War. Body (net/ an nk) AEC(s): ❑ BEA ❑ INA ❑ UW SPIMA ❑ PWS Closest Mal. War. Body /Y/ /I ant m c / 5 t, t,, n si ORW: yes/ io PNA: yes/ ) Type of Project/ Activity 6 S T L� cx.�11 T r �. x -iS -T-i ,t , S h p r (Scale: qT3' ) Shoreline Length .- S 2 f Access Length "" ."�_ CL A' /✓ Pier (dock) length"- Fixed Platform(s) Cl'L4d Floating Platform(s) Finger pler(s) Total Platform area Groin length/N Bulkhead/Riprap length — Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathous Boatlift Beach Bulldozing Other ��! I ®. 9• g' zT•tCLY(Y: iti �" _\ i r �1— SAV observed: �- ��, Moratorium: -�,.� yes V no ---I --- — Site Photos: Riparian Waiver Attached: y�,. 4y 1 nc yes <rio PL A building permit/zoning permit maybe required by: Permit Conditions F.-UJ"z-C ftsc.r'f'oC.v. �jiciv r5�r� � Ir I i — BL P� ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT (Please Initial) K Agent or A Iica [ PR T a ne Permit Officer's PRINTED Name Signa�-Please read complRlt-e-natement on back of permit- . hvt Sign t e �ao sSl9se Application Feels) Check N/Money Order Issuing Date Expiration Date �CAMA ❑DREDGE & FILL N° 89053 G B C D GENERAL PERMIT Previous permit 3 Date previous permit issued New ❑Modification ❑ Complete Reissue ❑Partial Reissue 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 SA NCAC Tf—� a ❑ Rules attached. K56eneral Permit Rules available at the following link: www.deq nc gov/CAMArules City .S2a-'t—o�'Ar State V ZIP / !1 9 % -i Phone#() Email � -A d- M0. C t, n oleo w�aurnit...vm np. � Street Address/State Road/Lot #(s) / V % c j`-- ,.b Vr 4.r.�) C+, L, e o f s'J 1 Subdivision C,3 4F /!�t,4n iio_c C) ltr S9-c. Z. City Z Affected ❑ CW f*WF2fPTA ❑ ES ❑ PTS Adj. Wtr. Body (2_G/V /G- 1 (nartat/ nk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj, Wtr. Body A / h i2 rn a r- /� S n k n d ORW: yes/ PPNA: yes/ d6 Type of Project/ Activity Shoreline Length S 2/ Access Length Pier(dock)length Fixed Platform(s) -" Floating Platform(s) Finger pier(s) Total Platform area Groinlength/# Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathous Boatlift / Beach Bulldozing Other .5 fJ 4'�wciersc�-- SAV observed: yes no Moratorium: no Site Photos: no Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: Permit Conditions Cc (Scale: �JTS ) /p.ri tf /11os.t'Y�C.vr /Sf itc�.eiS°h U I i _ rL r�`t ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) N � ✓ 0 7 n 2 � o_rV2_i Agent or Applicant PRINTED Name Permit Officer's PRINTED Name 1'r'r'L Signature -'Please read compliance statement on back of permit" Sign t e qb-. sXMI y�z`f"Y Application Feels) Check #/Money Order Issuing Date Expiration Date �l> '1 � X G{IIC, YCM. StT XYL- 0=RWA Q - YRW - ,iti9IXii wA4An - ARfl 1EtG cxt P[MSIK <.hi.v an nP ypryiuu - CJR XNDR.R ��O �-flZCT 1fl.WS NP - N Delia ec - w awE —E PL - P,iC4Nn LK VICINITY MAP NTS w - r6Rn IMA p - eacFUNeR rl W LOT 49 !b I Z NF.LP iCNE I Rf E. 60) � ` NILP. ZLY1f � (R.f P.460'j tl LINE TABLE` EwE 1 mm ze,6 ° L-I f1 S1CO 1 0 9z� � tr LOT 50 iC m yr 1, .1 'AEA of . NM ("'. 901 2 .r- / Mp °s u {I.P.ZMF vROPOun a s. W FRFYEA / IPfP[ 60') lip DM . ~- 1 ym[ntt a+sue I _ i i i J Ib I ! n I i O X N M CLUB VIEW CT - ,,i15 Sf 39: o.R. IR66. M N] x H16ZW..VE PER flE OT[R SRhL'S p YY5r &'FXxIE6 N E W. W SP (b 6X) 4NPX6 (MII M) 1 III I 1 LOT 52 I I I 1 1 1 .t • — (e0 R)W) _ NC7T—ACERTIFIED DOCVMEi NT" xn w'v: °]foin2i mmxem t°tP""nK sR Pwl AS TO THE ORQN.AL. BUT OM-'t AS TO T AE FiE1aM tlUa VEW CT R[V, w m .'Poi 6fl6Mx 6vcO�6Ra SURVEY FOR BRUCE DOPLER AND WIFE, GINA ALDERSON LOT 50 - SECTION 0 - COLINGTON HARBOUR ATLANTIC TOWNSHIP - BARE COUNTY - NORTH CAROLINA 20 i°® SEABOARD SURVEYING & PLANNING. INC. C-1539 I Inch - 2tl It ICY W. 'WOOD HILL OR, P.O, BOX 58. NAGS HEAD, NC 27959 mp OMM (252) 480-9998 FAX: (252) 480-0571 lL. 2n{gA6 $VRN"EGP] a3'2I A PI,AIRU'.OJ M 2x 4. AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Bruce Dopler & Gina Alderson Mailing Address: 8 SAND PEEBLE DR - SEAFORD, DE 19973 Phone Number: Email Address: (304) 542-6492 bandg9(aDgmail.com I certify that I have authorized rine Constructio to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Installation of 8K Boat Lift on existing pilings adjacent to pier built in 2023. at my property located at 101 Club View Ct., Colington Harbour, Kill Devil Hills NC, in Dare County. 1 furthermore certify that 1 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 Information: Signature Bruce Dopler Print or Type Name Property Owner May 17, 2024 Title Date This certification is valid through I I 24-0516 SJC DOPLER BL AgentAuthorization Final Audit Report C AMA 2024-05-17 Created: 2024-05-17 By: Jane Etheridge -Small (bookkeeper.ablemarine@yahoo.com) Status: Signed Transaction W: CBJCHBCAABAAY5VOat UkBOV-zmT4HtfufyN2t2DCOXCu "24-0516 SJC DOPLER BLC AMA AgentAuthorization" History f} Document created by Jane Etheridge -Small (bookkeeper.ablemarine@yahoo.com) 2024-05-17-4:30:04 PM GMT- IP address: 47.133.148.241 v Document emailed to bandg9@gmail.com for signature 2024-05-17 - 4:36:20 PM GMT Email viewed by bandg9@gmail.com 2024-05-17 - 4:36:26 PM GMT- IP address: 66.102.8.33 A0 Signer bandg9@gmail.com entered name at signing as Bruce Dopler 2024-05-17 - 7:31:58 PM GMT- IP address: 174.216.49.8 o Document e-signed by Bruce Dopler (bandg9@gmail.com) Signature Date: 2024-05-17 - 7:32:00 PM GMT - Time Source: server- IP address: 174.216.49.8 10 Agreement completed. 2024-05-17 - 7:32:00 PM GMT Adobe Acrobat Sign N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM CFRTIFIEDMAS • RETttF t„NECEIPT REOUESTE6 or HAND pEUVERY (TOP portion to be COMPielad by owner or their agent) — Name of Property Ovate : Bruce Dopier and Gina Alderson Address of Propertyr. 101 Club Yew CT., Codington Harbour SID, Kill Devil frills, NG 27948 Haling Address of Owrron Colwhgtat Ns+iriwr Sd),JGIjI Davll t#&ta NC 27046 Owner's email: ; _„,• Owners Prioriek Agent'sivane.' 'w wman xa.,�c�..wu'a:nucAgent 1 252 573-BO43PhD Agent's Email- abxdrcanvworksr'rpyahop.Core .. �. ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom ogruon to be ootnolstod py the Adio rinjt Pigwdv Ownori I hwe4 certify that 1 own property adfrei to the above rororencad property, The Individual applying for this Permit has described to me, as shown on the attached chawing, the development they are proposing. to dos=gen or drays ftg Lvtdh qjetanslons m tit Mavded with th' falter. 1.00 NOT have Objections to this proposal _ 100 have objection to this proposal. Managemorrt tt7CM) in writing within fg days of recerpt of this notice. Correspondonce shoukt be mated to 4011 S. Griffin St, Mo. ZIM Elizabeth City, NC, 27999, OCM rsptesenWtives can also ba cenlaetM Of (251) 264-3901. No response is considered the same as are objection if you have been notified by Certified Mi WAIVER SECTION I understand that any proposed plot, deck, mooting pilings, boat ramp, breakwater, twathouss Idt, or groin must be set back a minimum distance of Whom my area of riparian access unDess worwid by has (this does mat apply to buidl ends or igerap revetments). (If you wish to waive the selbai you mast Sinn the appropriate blank below.) an - � _a�f OR- do not ish to vaeve the 16 seSramck requirement (initial the hunk) Signature of Adjacent Riparian Printod mermiof Ali .._,. Mailing Address of ARPO:---- I <f3h )(�,,,,. ARPi small:. t(kSP w-tY1A (u'�a, t:4r,•,.NARPO' Phantr#:. Y:si Dsts:.�! �rt zc%L ._J.,'waiver Is veld for up to one year from Welch, 2002 Hwnour View Or, Colinghte Tarnow, Ktli Dwd HUig, Nt, 27! Jut Dupree Boat Litt V" N 0 0,4 j V c'?I(. C~ W Rl zme- D V� /q LIKA-1 t- SlIy/Zi Able Marine Contractors, LLC 101 Airstrip Road, #390, Kill Devil Hills, NC 27948 obxdreamworks(&vahoo.com Telephone (252)573-8043 April 25, 2024 SENT BY FEDERAL EXPRESS John R. Welch, Trustee C/O Robert Welch 6 Lesh Court Middletown, DE 19709 Re: Bruce Dopler and Gina Alderson Proposed Project — Install 8K Boat Lift on Four filings Installed Last Fall Dear Mr. Welch: I have been hired by your neighbors, Bruce Dopler and Gina Alderson, to install an 8K Boat Lift on the existing four pilings shown on the attached survey that we installed in the fall of 2023. All construction will take place at 101 Club View Court, Colington Harbour S/D, Kill Devil Hills, NC 27954, which is adjacent to your property located at 2002 Harbour View Dr, ,e. Attached is the CAMA Adjacent Riparian Property Owner Notification / Waiver Form, that CAMA requires you to complete, along a copy of CAMA Permit 489958 dated September3, 2023 showing where Pilings were installed for a future Boat Lift. Please make sure to follow the instructions below to complete this form: 1. Under the Adjacent Riparian Property Owner's Certification section: YOU WILL INITIAL beside the appropriate line verifying: I DO HAVE objections to this proposed project or I DO NOT HAVE objections to this proposed project. 2. NEXT under the Waiver Section: PLEASE SIGN YOU SIGNATURE on the appropriate line verifying: If you wish to waive or do not wish to waive the 15' setback requirement to this proposed project. 3. PLEASE SIGN YOUR SIGNATURE AT BOTTOM OF the form, where indicated, and insert/ fill out your information as requested. 4. After you have completed the form, please return it to me in the pre -addressed, stamped return envelope as soon as possible. Able Marine Contractors, LLC 101 Airstrip Road, #390, Kill Devil Hills, NC 27948 obxdreamworks(a-vahoo.com Telephone (252)573-8043 Continuation of Welch Letter April 25, 2024 Page 2 After you have completed the form, please return it to me in the pre -addressed, return envelope as soon as possible. Should you have any objections to this project, please send your written comments to North Carolina DEQ, Ronald Renaldi. CAMA AGENT, Division Coastal Management, Elizabeth City District Office, 401 S. Griffin St., Suite 300, Elizabeth City NC 27909 within 10 days of your receipt of this notice. Such comments will be considered by the Department in reaching a final decision on the application. No comment within 30 days from the date you receive this notice will be considered as no objection. Please call me when you have received this letter and with any questions you have on this project. Please call me at (252) 573-8043, or email me at obxdreamworks(&yahoo.com. I look forward to hearing from you and thank you in advance to your prompt attention in this matter Sincerely, Jason Wall Enclosures: Adjacent Riparian Property Owner Statement Form, Copy of 9/12/23 CAMA PERMIT showing Pilings where Boat Lift will be installed N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: Bruce Dopler and Gina Alderson Address of Property: 101 Club View CT., Colington Harbour S/D, Kill Devil Hills, NC 27948 Mailing Address of Owner. Colington Harbour SID, Kill Devil Hills, NC 27948 Owners email: Owner's Phone#: Agent's Name: Jason w. wan of Able Marine Construction. ttC Agent Phone#: (252) 573-8043 Agent's Email: obxdreamworks@yahoo.com ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent Property Owner) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me, as shown on the attached drawing, the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. _ I DO NOT have objections to this proposal. I DO have objections to this proposal. ff you have objections to what is being proposed, you must notify the N.C. Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Griffin St., Ste. 300, Elizabeth Cffy, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. No response is considered the same as no objection if you have been notified by Certified Mail. NTE PI =1Z�"=101 11183 I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me (this does not apply to bulkheads or riprap revetments). (if you wish to waive the setback, you must Sian the appropriate blank below.) I DO wish to waive some/all of the 15' setback , / I lsi/ L Signature of Adjacent Riparian Property Owner -OR- do not ish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: `3J j Od) Typed/ Printed name of ARPO: &, i 0,� 1 t ) Mailing Address iof ARPO: ! `e' ,) 4 J(4,_ A 1 ci J 6 � 4 I 1 ARPO'sLe�mra,,il: rk_9T /.�r� �lfz/ 8a^,�ARPO'sPhone#: �Z"�1�-' -� loj) Date: ! 1?) t) ZW Z Y "waiver is valid for up to one year from ARPO's Signature` Welch, 2002 Harbour View Dr, Colington Harbour, Kill Devil Hills, NC 27948 Revised July 2021 :for Dopler Boat Lift oLO o c O O V) M N L W pajl}aq lsnw swrep w Lij ur CL '8a'WO'[$slamen fire V v ^ 0 �p pazuoyine ayi+o 00[$}0. r P., � .y M > pue's}tw `saa}s,hawi (.f 2 N N > ; f� _gym woy>anox> olwOulnoF� 'Q W Z N _� 0 N ui luaum�op `a7uey�le�n ,�1v4.,�j� a 0 Y N Y Z �Z tNj.M 'aBeweP`�I�iles �= i UQ CLo IJ C �... Q� -=-0 CO Z uo algepene •aping U O N\ Q N e Z mCj t O Q O 0 C i N Gr N .� '0 Q Q ` W h Q 2 ��. v �{ .�- < > F° L o m c� a W � V Q cc Ci 9 J Uc 0 o t}a v wx W0) O ra 0 !� ,Si N H W � V`v N O 1 x N ti LO a �® M co ti Cfl ti Y cn r N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: Bruce Dopler and Gina Alderson Address of Property: 101 Club View CT., Colington Harbour S/D, Kill Devil Hills, NC 27948 Mailing Address of Owner: Colington Harbour S/D, Kill Devil Hills, NC 27948 Owner's email: Owner's Phone#: Agent's Name: Jason Wall, Able Marine Construction LLC Agent Phone# (252) 573-8043 Agent's Email: obxdreamworks@yahoo.com ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent Property Owner) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me, as shown on the attached drawing, the development they are proposing. A description or drawing with dimensions. must be provided with this letter V' _ I DO NOT have objections to this proposal . _ I DO have objections to this proposal. If you have objections to what is being proposed, you must notify the N.C. Division of Coastal anagement in writing within 10 days of receipt of this notice. Correspondence s ou be mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the appropriate blank below.) I DO wish to waive some/all of the 1 setback Signature of Adjacent Riparian Property Owner -OR- I DO NOT wish to waive the 15' setback requirement Initial here: Signature of Adjacent Riparian Property Printed name of ARPO: Mailing Address of ARPO: 105 Club View Court, Kill Devil Hills, NC 27948 Typed/ ARPO's email: alidredneplumbing@gmail.com ARPO's Phone#: (252) 619-1612 Date: *Please note waiver is valid for up to one year from ARPO's Signature* Alldredge 105 Club View Ct Colington Harbour, Kill Devil Hills, NC 27948 for Dopler Boat Lift Revised July 2021 Able Marine Contractors, LLC 101 Airstrip Road, #390, Kill Devil Hills, NC 27948 obxdreamworks(&vahoo.com Telephone (252)573-8043 May 1, 2024 HAND DELIVERED and Reviewed on May 17, 2024, to Joycelyn Alldredge John and Jocelyn Alldredge 105 Club View Court Kill Devil Hills, NC 27948 Re: Bruce Dopler and Gina Alderson Proposed Project — Install 8K Boat Lift on Four Pilings Installed Last Fall Dear John and Jocelyn I have been hired by your neighbors, Bruce Dopler and Gina Alderson, to install an 8K Boat Lift on the four pilings shown on the attached survey that we installed in the fall of 2023 when we built the pier for Bruce Dopler and Gina Alderson. Installation of the boat lift will take place at 101 Club View Court, Colington Harbour Subdivision, Kill Devil Hills, NC 27948, which is adjacent to your property located at 105 Club View Drive, Colington Harbour. I previously attempted to send this information to you by Certified Mail on April I but the post office shows it is still out for delivery. Attached is the CAMA Adjacent Riparian Property Owner Notification/Waiver Form, that CAMA requires you to complete, along with a copy of the CAMA Permit #89958 issued on September 12, 2023, that shows the installation of four pilings for a future boat lift that we are applying to install now. Please make sure to follow the instructions below to complete the CAMA ARPO Notification form: 1. Under the Adjacent Riparian Property Owner's Certification section: YOU WILL INITIAL beside the appropriate line verifying: I DO HAVE objections to this proposed project or I DO NOT HAVE objections to this proposed project. 2. NEXT under the Waiver Section: PLEASE SIGN YOU SIGNATURE on the appropriate line verifying: If you wish to waive or do not wish to waive the 15' setback requirement to this proposed project. 3. PLEASE SIGN YOUR SIGNATURE AT BOTTOM OF the form, where indicated, and insert/ fill out your information as requested. 4. After you have completed the form, please return it to me in the pre -addressed, stamped return envelope as soon as possible. Able Marine Contractors, LLC 101 Airstrip Road, #390, Kill Devil Hills, NC 27948 obxdreamworks(&yahoo.com Telephone (252)573-8043 May 1, 2024 Continuation of Alldredge Letter Page 2 After you have completed the form, please return it to me in the pre -addressed, return envelope as soon as possible. Should you have any objections to this project, please send your written comments to North Carolina DEQ, Ronald Renaldi. CAMA AGENT, Division Coastal Management, Elizabeth City District Office, 401 S. Griffin St., Suite 300, Elizabeth City NC 27909 within 10 days of your receipt of this notice. Such comments will be considered by the Department in reaching a final decision on the application. No comment within 30 days from the date you receive this notice will be considered as no objection. Please call me when you have received this letter and with any questions you have on this project. Please call me at (252) 573-8043 or email me at obxdreamworks(a-yahoo.com. I look forward to hearing from you and thank you in advance to your prompt attention in this matter. Sincerely, Jason Wall Enclosures: CAMA Adjacent Riparian Property Owner Notification/Waiver Form, CAMA General Permit #89958, and Copy of a Marked -up Survey showing location of Boat Lift ❑DREDGE & FILL N9 89958 661) s C D Previous permit GENERAL PERMIT Date previous permit issuedy"_ (\]New ❑Modification ❑Complete Reissue ❑ Partial Reissue 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: 15A NCAC I ji - i �-O0 Rules attached. 14 General Permit Rules available at the following link: www.deo nygov/CAMA ule= Applicant Name f.i t ! £ �it lsG Ani v, o Authorized Agent Address AL riuC.-!! Project Location (County): City ,S Ca• u : State. _ Zip Sweet Address/State Road/Lot # (s) _ I O i 0, Phone #(3o�a Str3.- f-441 — Lo f �O _tr�-C,t'+Ic. r �s2uEmail uvision.; —�— City n a. /�___ ZIP of z 4 Affected CW �EW PTA ES PTS Adj. Wtr.Body____""„__,,,_L"f..^a.i-___,_„_,_.,,___,______(nat�unk) AEC(s): OEA QIHA UW SPIMA PWS Closest Mai. Wm. Body /Y iIk rat. r(4 :50 V^.Ci ORIN: yes/ o, PNA: ye6�> _._.. _. Type of Project/ Activity i' )t s r CC w d 4' X t•i ' I o..,�.A-P_.�1a �" �!'+ 7 P�_��✓ ice 1•� L3.�« h l ,"� Y (Scale: JX-r % j Shoreline Length Access Length Z_�_ •.. (\` ier a ock}length CCn ' Platfo�m�3 _�-4-�•Y. 4' &+,.r1.4'} a� ,..-, ... � V Floating Platforms r a K. rtt< ^ Finger pier(s)_ K" Groin length/tf_...... __ A,\ Bulkhead(RiPraP Iatgt1h o \ .^` 13 \tQ Avg distance offshore \�\ \\�\\� � d'� t N dkj' Breakwater/Sill Max distance/ length _ CA 10 Basin, channel Cubic yards .---_— p\oF �w•,v,S S Boat ramp._._ __- p,,� I J ` }�o,jt\a.r - ( iJ„jrlc! Boathouse/Boatfift .__._.� bcn2 d I e, ' ;\i\�t'LAir- BeachBulldozing-_......__�j "rsL }\r��•v.r>„r, ,4 ^c1,>'w"/'` I Air there PAq iNct-cr SAV observed: yes CdV t')" Moratorium: 4�5ay �yes no ywes Site Photos: s} ra Riparian Waiver Attached: yes ev A building permit/zoning permit may be required by: TAR/PANUNEUSFJBUFFER (circle one) Permit Conditions _ _.". __ __. _.._ __ ___ See note or, back regarding River Basin rules See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS, THAT APPLY 70 THIS PROTECT AND REVI EWED COMPLIANCE STATEMENT. (Please Initial)x L7 ... 12 �W }�"�-'•3- i Agent or Applicant PRINT Napie ( Permit Officei s PRINTED Signat '"Please rea plianre statement bolack of permit" A-kCLQ,s -_._.. _........ .... .._...___. 1#.r`✓- i.�rj��_--t--1�~� r10 .)-� lii (,�i:s .iy Application Feels) Check g/Money Order Issumg Date Expiration Date