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HomeMy WebLinkAbout75398_Malinda Ray_20200602 :ACAMA/ -6 DREDGE & FILL �D W�a / No. 75398 GENERAL PERMIT Previous permit# 1li/}A �B> C lNew f Modification (_)Complete Reissue `IPartial Reissue Date previous permit issued As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC V-//0 0 / ?/r•I ZOO ,0 y)Rules attached. Applicant Name j l&I 1`dtk f�,_ _- _ Project Location: County , L i Address IQ-Dptrr.f '1 Street Ad ress/State Road/Lot#(s).j ? 4 & . z City r N State AR- zip a 3 SJU a.__ . —_ L Phone#( .3_ Q /sL6 E-Mail _- Subdivision . Authorized Agent lG' z.-1 4 ...&i/d j.. tz-C- City 0 - ZIP 2 5/C) Affected ) W `111EW X PTA rES lxPTs Phone# (/ 3)o zO / -� River Basin A/p,..._$.�_ S _ OEA L HHF C IH Lii UBA I-1 N/A AEC : Adj.Wtr. Body "`El PWS: (/k /man1unkn) ORW: yes /fl,�'b) PNA yes Closest Maj.Wtr.Body-/ G" /r Type of Project/Activity j Ce e nte�c --t � Sn L. 5 0' .G/- eXiii .46 x/Z1,4 �+- -/-_ /v a r /4 c� en /�/f f y� (Scale: f 2 ) Pier(dock)length __ , ' Fixed Platform(s)_- / /�(21 _ r G� Floating Platform(s) - Finger pier(s) I j Groin length j '_L._ , 1 /izJIa i - — /Ks�Kv� number -{I- i I x/2 4___ i l' --/ - ..1__' �?r°r 1 _j.._.� -.. _.l-__ I--. __.?._..1. Bulkhead/Riprap length i I • avg distance offshore O • --- I. i {�f y` max distance offshore C� 7`1 Basin,channel _ $ cubic yards - al•'1JD eY ..t/4-1-a cw4 Boat ramp R_ I G" 1 Z.- PO'rbe-4, ___ . i Boathouse/Boatlift 1..)A°r' wr{-t.0 I lRLr 1 M4 Beach Bulldozing ___— l 'FLAG,S I —" Other .-- �~f —_ 1! W lr Shoreline Length_ /00_ - 1 I Y V N z_. • .,-7 SAV: not sur ^ yes no al -. - , , , Moratorium: n/a yes ® l J Jkk O � `V `i� 'Pre--wCP' AR.2 �� '�,p �°I Photos: yes no ' i i� Prap1 Waiver Attached: yes o �s A building permit may be required by: P /r'-O (-/� • . li-;See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions '0ti e-�ti€ ,4-z-11-)+3n.ie-r- Tz3 S E ?"-/o ",a,¢ L `✓x: 1.441 - ) -t- o-,-1 �f (..1)/ -i - ,-•G7Z+H 4/ 'Ft_LTG,< , E.>2-4-)5io•••�/ rqa? tn 1 ) toPLA-J7. / I �/70 /Py�P 0A. ,....,/A VVIWC N'`�' c-(1OuCC% � a -, John Gudaiti/ ' 17=it...c•.-1 Agent or:-.lic. Tinted Name Permi fficer's Printed Name .00 j _ . Signa dli- *Please read compliance statement on back of permit** ign tune 14 1 Le U Cl r )19 2, 2 -Si.1--i �2c� D - 2 Hai twt Zv'i-c> 4 .plication Fee(s) Check# Issuing Date Expiration Date ROY COOPER ' Governor MICHAEL S. REGAN Secretary Coastal Management BRAXTON DAVIS FNNRONNENTALOUALtrf Director BUFFER AUTHORIZATION CERTIFICATE FOR SHORELINE STABILIZATION A riparian buffer authorization is required for shoreline stabilization activities within the Neuse and Tar-Pamlico River basins per Division of Water Resources(DWR) regulations 15A NCAC 02B.0233 and 0259. The Division of Coastal Management(DCM)through a Memorandum of Understanding with the Division of Water Resources(DWR) has reviewed your project proposal and has deterrnined that the project as proposed complies with the aforementioned regulations. Those activities covered byyour.Coastal Area Management Act(CAMA)permit have received Buffer Authorization provided the project is constructed in a manner that continues to meet all of the conditions listed below.Failure to comply with this Buffer Authorization may subject the property owner and the party(contractor) performing the construction and/or land clearing to a civil penalty by DWR of up to$25,OQO per day per violation. 1. Impacts: Impacts to woody vegetation from clearing and filling in Zone 1(begins at the most landward of either normal water line(NWL)or normal high water line(NHW L)and extends 30 feet landward)shall be minimized to what must be impacted for the sound Installation of the shoreline stabilization project. Unnecessary clearing and . filling in the buffer is a violation of the riparian buffer rules. • 2. Clearing&Grading:Clearing and grading of Zone 2(begins at the landward edge of Zone 1 and extends 20 feet landward)is allowed provided that it is re-vegetated immediately and Zone 1 Is not compromised,which includes maintaining diffused(non-channel ized)flow of storm water runoff through the buffer. 3. Construction Corridors:Construction corridors are allowed for shoreline stabilization projects,but they must be satisfactorily restored as described in condition 5 below. 4. Potential overWash:'For vertical shoreline stabilization projects(bulkheads)only;sites where wave overwash is expected to be severe,the first ten(10)feet landward(unless specifically authorized otherwise by DCM)from the structure may be maintained as a stable lawn in order to provide for structural stability. s. Temporary Stabilization:Immediately post-construction,bare soils must be stabilized as quickly as possible by providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting. This ground cover is a temporary measure used to address erosion until site restoration can be accomplished. 6. Site Restoration:At minimum,pre-project site conditions must be re-established.A site that was wooded prior to this shoreline stabilization project must be restored with woody vegetation at a stem density of 260 stems per acre. Non wooded sites may be re-vegetated with woody vegetation.Restoration must be completed by the first subsequent planting season(November 1 through March 30)after completion of the bulkhead. • Pre-project site conditions: C0rttrn-L t.O4PIt,4.e.by o Mra,e n-1,L-0 LAD-A',.1, 7. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property indicating the location of the shoreline stabilization structure and any associated clearing,grading,and construction corridors.This drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the a boy ee,.1y�-sted conditions and verify that all information is complete and accurate. John Gudaitis � Agent or Ap inted Name ermit Icer z Mt r-Ler 2-.20 Agent or li nt Signature Issue Date CAMA GENERAL PERMIT it: 753 9€— 33 , State of North Carolina 1 Environmental Quality I coastal Manag meat WashingtonOfhce 1943 Washington Square Mall Washngton,NC278891252-946-6481 Wilmington Office 1127 Cardinal Drive Ext.WBmington,NC 28405-38451 910-796-7215 Morehead City Office 1400 Commerce Avenue Morehead City,NC28557 1252-808-2808 Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action;and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief,certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: j Tar-Pamlico River Basin Buffer Rules Other: Neuse River Basin Buffer Rules If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office(910-796-72 I 5)for more information on how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ I-888-4RCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (Serves:Carteret,Craven,Onslow- (Serves:Beaufort, Bertie,Hertford,Hyde, North of New River Inlet-and Pamlico Tyrrell and Washington Counties) Counties) Elizabeth City District Wilmington District 401 S. Griffin St. 127 Cardinal Drive Ext. Ste. 300 Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 Fax: 252-264-3723 (Serves:Brunswick,New Hanover, (Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet- Dare,Gates,Pasquotank and Perquimans and Pender Counties) Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 gy COCAMA/ el DREDGE & FILL No. 75398 ) C D GENERAL PERMIT Previous permit# A//}A B > I$New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued Ail} As authorized by the State of North Carolina,Department of Environmental Quality '`L//O 0 and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC /' 78.1 WO • �m ,0 ,�j D I Rules attached. Applicant QName / 'd"I'/�"'1°t Lvey Project Location: County ,/'lLvl !/e...D Address I •opE e 57 Street Address/State Road/Lot#(s),9.9Z G,../ary City 44104 D C. State He. ZIP a a 5(p lei bit- /30 v Phone#(7O5 2.1 o /VC. E-Mail // ,, Subdivi ion er Authorized Agent 4 iz.vri p/t /..-//GLrj [yC City ArA-4 ZIP z 5/O Affected / CW XEW XTPTA if I%PTS Phone# (7-95)0120 /AC. River Basin Afrpr._. 5 0 _ AEC(s): HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body .' , C4 . b/man /unkn) 0 PWS: ,/ Closest Maj.Wtr. Body /✓G"Z��� ORW: yes if" PNA yes o A p Type of Project/Activity ?reraBa( -t-n Incd,etQe_ ro I ..?../' tad /z2X/Z/QA44' cz t<2 -( /0 0 ' cr/4 &7 /� /�f/ F/�7y�i (Scale: t:Za ) Pier(dock)length 5 r r Fixed Platform(s) fj�K l2t ,� �OL �. Floating Platform(s) jl ��iN Finger pier(s) Groin length �a 7 . number • OlatX/2 --'" en' Bulkhead/Riprap lengthy`'/dp/ tvr avg distance offshore 0 it I max distance offshore L) !�'`s ip I Basin,channel 'I wT`•� cubic yards v.1.1p ey-c L rs`J p� n Boat ramp n . l t i / IOS�O'�e.p' �— 1 Boathouse/Boatlift nit wM.f� j6a�f�- = y,>s-rt ,-b _ Beach Bulldozing 'FL/AL S �� I Other _!�• _VS. Shoreline Length �'/C0 .w� V ,I �J �— SAV: not sur yes no F r }�nG' c�L WfL> F`_^—/!'+�.= - I �, + /� Moratorium: n/a yes ® � (�S Mo ,�- fi t'-C� �+-c '.Ln) � Photos: yes nb -7 ^ VV''�� y roi3 Waiver Attached: yes a //r� A building permit may be required by: P //CO C_.& • . . gi See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions "a Li t-r't u° Mz,t,4oner11.; -ra $e- 7-/o �,a¢77 1-nt M-t -re-te 1.4.q4.0 -1i1.31-1 7-r1r Mtn, 1rni4. L.-t?vA-,-30 e-' t,.c . par�S.>.-- la r -7'rr-n rt) to P t/k 7JO. 4 - f/, "- "—r `/7 y/0/ 4a+'en- w/avvl4yNAv..- c-((on,.1ecO &SO P'tut Agent or Applicant Printed Name Permi fficer's Printed Name Signature *^`Please read compliance statement on back of permit** ignature oA d CIA t % �D ° 11 el2 2-Sw t-3-Tr, I-cap 'ZOGrr>gbo, "-I-aim-0 alication Fee(s) Check# Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief,certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar-Pamlico River Basin Buffer Rules I I Other: ONeuse River Basin Buffer Rules If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the Wilmington Regional Office(910-796-7215)for more information on how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ I-888-4RCOAST 252-946-648 I Fax: 252-247-3330 Fax: 252-948-0478 (Serves:Carteret,Craven, Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet-and Pamlico Tyrrell and Washington Counties) Counties) Elizabeth City District Wilmington District 401 S. Griffin St. 127 Cardinal Drive Ext. Ste. 300 Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 Fax: 252-264-3723 (Serves: Brunswick, New Hanover, (Serves: Camden, Chowan,Currituck, Onslow-South of New River Inlet- Dare,Gates, Pasquotank and Perquimans and Pender Counties) Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 ROY COOPER - -- ?.? Governor MICHAEL S. REGAN Secretary Coastal Management BRAXTON DAVIS ENVIRONMENTAL 0UMI1 Director BUFFER AUTHORIZATION CERTIFICATE FOR SHORELINE STABILIZATION A riparian buffer authorization is required for shoreline stabilization activities within the Neuse and Tar-Pamlico River basins per Division of Water Resources(DWR) regulations 15A NCAC 02B.0233 and 0259. The Division of Coastal Management(DCM)through a Memorandum of Understanding with the Division of Water Resources(DWR) has _ reviewed:your project proposal and has determined that the project atproposedcomplies_with_the_aforementioned regulations. Those activities covered by your Coastal Area Management Act(CAMA)permit have received Buffer Authorization -- provided-the-projectis constructed-in a mannerthat continues to meet all of the conditions listed below. Failure to comply with this Buffer Authorization may subject the property owner and the party(contractor) performing the construction and/or land clearing to a civil penalty by DWR of up to$25,000 per day per violation. . 2. Impacts: Impacts to woody vegetation from clearing and filling in Zone 1(begins at the most landward of either. normal water line(NWL)or normal high waterline(NHWL)and extends 30 feet landward)shall be minimized to what must be impacted for the sound installation of the shoreline stabilization project. Unnecessary clearing and filling in the buffer is a violation of the riparian buffer rules.2. Clearing Clearing&Grading:Clearing and grading of Zone 2 (begins at the landward edge of Zone 1 and extends 20 feet landward)is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes maintaining diffused(non-channelized)flow of storm water runoff through the buffer. • 3. Construction Corridors:Construction corridors are allowed for shoreline stabilization projects, but they must be satisfactorily restored as described in condition 5 below. 4. Potential OverWash: For vertical shoreline stabilization projects(bulkheads)only;sites where wave overwash is expected to be severe,the first ten(10)feet landward (unless specifically authorized otherwise by DCM)from the structure may be maintained as a stable lawn in order to provide for structural stability. s. Temporary Stabilization: Immediately post-construction, bare soils must be stabilized as quickly as possible by providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting. This ground cover is a temporary measure used to address erosion until site restoration can be accomplished. 6. Site Restoration:At minimum,pre-project site conditions must be re-established.A site that was wooded prior to this shoreline stabilization project must be restored with woody vegetation ata stern density of 260 stems per acre. Non wooded sites may be re-vegetated with woody vegetation. Restoration must be completed by the first subsequent planting season (November 1 through March 30)after completion of the bulkhead. • Pre-project site conditions: t°n-5-rAct LO-E, 5 •A-1JO ,1-ta,? 'tPns4„O i_A. I-1 . 7. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property indicating the location of the shoreline stabilization structure and any associated clearing,grading,and construction corridors.Thls drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the above 'sted conditions and verify that all information is complete and accurate. Agent or Applicant Printed Name Permit officer e 'L S., r-1 - 2e2v Agent or Applicant Signature Issue Date CAMA GENERAL PERMIT#: —753 R`d r 3 ' • State of North Carolina I Environmental Qualtty I Coastal Management Washington Office 1943 Washington Square Mall Washington,NC 278891252-946-6481 Wilmington Office 1127 Cardinal Drive Ext.Wilmington,NC 28405-38451 910-796-72155 Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 1252-808-2808 AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS • Name of Property Owner Applying for Permit: Ill eykfra&1-atj Mailing address: r%D. X. 37 a o2 , Cr, USsio • Telephone Number: 70 R- 2i2A— ) 9 zip RIkr-fre ' )LL4 I certify that I have authorizedGba 72 i vertht (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits Melinda Ray necessary for the proposed development of (,(ftp.1-oi e o-., ® rJgrymic..40 (1'a1T.Q! nil-Arrdy at my property located at 3 77 2- rag,her) gc1. 1 4-ago-Ii a C, ,NL z9 S7o Owner 1 This certification is valid through September 30, 2020 (date). (Property Owner Information) Signature YY1 eLteriet (703) 220-1826 Print or Type N me Owner Title, co. owner or trustee for property melwvnc@yahoo.com Date (703) 220-1826 Telephone Number melwvnc@yahoo.com Email Address C co I. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1 , 2, and 3. A. Signature ■ name and address on the reverse ❑ A nt yourXCLAW so that we can return the card to you. 52knoift pent a) • Attach this card to the back of the mailpiece, B. Receivediv by (Pri ed N ) C. Date/ f D live c 2 or on the front if space permits. £ Od /j'L, - g,i rI 1. Article Addressed to: D. Is delivery address dill t from item 1? ❑ �--- If YES, enter delivery address below: No ti ° ` 1111-6/76/A- l24?-41M/it.- / - / z 't %ic3,-zur' ....„ Aopzitoe, f'‘ zgvo 3. Service Type ❑ Priority Mail Express®❑ Adult Signature ❑ Registered MaiITM ❑ Adult Signature Restricted Delivery 0 Registered Mail Restricted 9590 9402 5933 0049 2131 80 oleCertified Mall® O Certified Mall Restricted Delivery a Delivery etu Receipt for ❑ CoPlect on Delivery Merchandise 2. Article Number (Transfer from service label) ❑ conc3Pt ^" --'y Restricted Delivery 0 Signature ConflrmationTM 7904 � ❑ � 77. .8. 3. ❑ Signature Confirmation 019 ❑7 a a 0001 cted Delivery Restricted Delivery 7 III PS F • , u y 015 PSN 7530-02-000-9053 . • , Domestic Return Receipt CO U E USPS TRACKING # C° First-Class Mail Postage & Fees Paid USPS Permit No. G-10 a) ' c co 9590 9402 5933 0049 2131 80 United States • Sender: Please print your name, address, and ZIP+4® in this box* Postal Service /2IVe4j4ff Aka)361fit g;,,z- Rif 2ffcCO ' � �' F i fl � ili�'�l�3•=•2 f�•�•t:! ! ! !•j! ! f•!•! "! � � i`I ! t . l,t• f! � VERFRONTBUILDERS 3614 Fort Road New Bern, NC 28560 RIPARIAN NOTIFICATION LETTER FOR CAMA PERMIT Certified Mail—Return Receipt Requested May 12, 2020 Michael&Tina Tomlinson 2613 Northwoods Drive Jacksonville, NC 28540 Michael&Tina, Riverfront Builders, LLC(dba Riverfront Docks) is an authorized agent for property owner Melinda Ray. We are applying for a CAMA permit to install a 50'dock along the edge of her property adjacent to Dawson Creek, located at 3772 Janiero Road in Pamlico County in Arapahoe, North Carolina. The specifics of the proposed work are in the enclosed form and drawing. As the adjacent riparian property owner to the aforementioned project, I am required to notify you of the development in order to give you the opportunity to comment on the project. Please review,sign and return the attached form and drawing. Should you have any objections to this proposal, please send your written comments to Roy Brownlow, District Manager at 400 Commerce Avenue in Morehead City, NC 28557 within 30 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 of your receipt of this notice will be considered as no objection. If you have any questions on this project, please call me at (252) 675-8210, or e-mail me at john@riverfrontbuilders.com Sincerely, John Gudaitis Riverfront Builders, LLC authorized agent for Melinda Ray Enclosures: Adjacent Riparian Property Owner Statement ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Melinda Ray 's (Name of Property Owner) property located at 3772 Janiero Road, Parcel H094-44 (Address, Lot, Block, Road, etc.) on Dawson Creek , in Arapahoe/Pamlico County , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatio I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) DAWSON CREEK Dock Repair Existing Boat 1 House TOMLINSON PROPERTY RAY BELANGIA PROPERTY PROPERTY WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. `#`J'- I do not wish to waive the 15' setback requirement. (Property 0 y' Information) (Adjacent Property.Owner Information) Signs . nature Joh .aitis/Riverfront Builders (agent) Michael &Tina Tomlinson Print o ype Name Print or Type Name 3614 Fort Road 2613 Northwoods Drive Mailing Address Mailing Address New Bern, NC 28560 Jacksonville, NC 28540 City/State/Zip City/State/Zip (252)634-9300 q/) _ ys _3q/>l Telephone Number Telephone NU er May 12, 2020 3 /27 z/ Date Dale / (Revised 6/18/2012) NC Division of Coastal Management 10 6 41 D Cashier's Official Receipt Date:2 :5'1/4- 20'ad � OD i v G k. t)'41- 1I'"? +'i.�j p U-C- 6 OCR Received From: $ Permit No.: ---2 6q`is -5 Check No.: j j � 2-. 3 3 Applicant's Name: P A-i-1 +,11:>4- `--\ County: M L1l v Project Address: 3 2 -� "-''- t rn-c.7 1�-'clt . / 1 �1P4-r}`�c ) Please retain receipt for your records as proof of payment for permit issued. Signature of Agent or Applicant: Date: Signature of Field Representative: U ��L—� Date: Z '' +` 1412-0 MC Division of Coastal Mgt Habitat Impact Computer Sheet Applicant ! ' eQP Date: C/Lit ze 7-0 General Permit tt: 753/q g Describe below the HABITAT disturbances for the application. All values should match he name,and units of measurement found in your Habitat code sheet I TOTAL Sq. Ft I FINAL Sq. Ft. 1 TOTAL Feet !I FINAL Feet I (Applied far. (Anticipatedfinal I (Applied for. (Anticipated final DISTURB TYPE ` Disturbance total disturbance. I ❑isturbance disturbance. Habitat Name Choose One I Includes any j Excludes toy fetal includes Excludes any • anticipated I restoration i any anticipated I. restoration and/or , I I restoration or I and/or emp I restoration or ' temp impact I 1 temp impacts) i impact an cunt) 1 temp impacts) amount) I . \\11 1 Zl wo Dredge❑ RI❑ Bath ❑ Other g I 1 17If 41- ! y it rP ! I.S`' e_ke..c_ I Dredge All❑ Both ❑ Other ril J I ID©-Pt /o8 lk i m /I 4/ Dredge❑ Fill❑ Both ❑ Other �] l��O J''f r�Q{�I . Dredge❑ Fill❑ Both 1] Other ❑ I 1 Dredge❑ Fill❑ Both ❑ Other ❑ I I Dredge❑ Fill❑ Both 0 Other ❑ I Dredge] Fill L Both ❑ Other ❑ , I I I Dredge❑ Fill❑ Both ❑ Other ❑ i I I I Dredge❑ Fill❑ Both ❑ Other ❑ j I Dredge❑ Fill Both ❑ Other ❑ I I Dredge❑ Fill.❑ Both ❑ Other ❑ ! I Dredge❑ Fill.❑ Both ❑ Other ❑ 1 I I It Dredge❑ RI❑ Both ❑ Other ❑ I I Dredge❑ RI❑ Both ❑ Other ❑ 1