HomeMy WebLinkAbout76053_Philip S. Purdue_20200622 �// �i'\/\,l
WCAMA/ E1 DREDGE & FILL Z (v(0I ,-7 N0. 76053 0C D
G,ENERAL PERMIT `'� Previous permit# ^/',q
ew CiModification LlComplete Reissue L)Partial Reissue Date previous permit issued 4//4
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 f✓�1 7�� 00
Rules attached.
Applicant Name_ /' A. era, Project Location: County /1r-�•--
Address .? 3_ice,- 1 c " /7 4 i (4,eitreet Address/State Road/Lot#(s) .2:__7 S S/✓e,-he L
City 61?-e-r.v..fib - State/VZIP v2 7I r ,.r ✓c n7/. __I- c'r,. _‘,-
Phone#(, ,?).-7Y4-?cea✓SJ E-Mail _CiN,c4 g6,.44,.,• co•"' Subdivision
Authorized Agent City Yc;i<c.ie 1? /cfe- ZIP .0Z7 p‘_0
'Lim L.7 EW Iterrs► L J ES Li PTS Phone# (- )_ • River Basin 7.3-c/Xen
Affected O OEA Cl HHF ❑1H =1 UBA p N/A
AEC(s): Adj.Wtr.Body- . .3';4,err i4J--- (nat /man) /unkn)
PWS: /9e-,-1 l�r�, N
ORW: yes /() PNA yes /� Closest Maj.Wtr. Body, ._ _ ok�
Type of Project!Activity , �/ y�•�,�� /w/ /.2 ' 1 1�c€xH) 44;cc h./ X«�,/
j ,4/4 ! (Scale: / ti. )
Pier(dock)length
Fixed Platform(s) — c � t
Floating Platforms) _ --— !✓v j L C,'N L r4-4 r 1 '�‘�s
i
Finger pier(s) N-P
f ar _ , i"
Groin length •i-_ . I-�!tj t_ _ —»...
number —- i
Bulkhead/Riprap length_ ! ._ •, io i ! I .: I_. ?
avg distance offshore __
max distance offshore I 4' 0 i
• Q
Basin,channel i
-
iltS
cubic yards I f`� i
Boat ramp .-- PI . . I ;.
Boathouse/Boatlift j I
Beach Bulldozing i I :_
(f• / + Y—y--... - . . ..
OtheriW t i s _yw/e. ( I II
/2' ,� �OCc. I1 1( 1
t .. !
Shoreline Length/&d=c 1 10 I , I i i..
SAV: not sure yes C)' _,N ki....,_ }
. ../...dt . ,
Moratorium: n/a yes CO ! In i . , uc 1" fPhotos: yes I ! /
Waiver Attached: yes no I i
A building permit may be required by: J/,- note on back regarding River Basin rules.
(Note Local Planning Jurisdiction�) / / //
Notes/Special Conditions ,fd i/c,.c/ .S!•,' ,i "c,- / rZc.-c-/,
s P� Jae tide_ MI . Lete- /-:-....- ...5/ //
ent or t' t Printe Name PermitOffi er's Printed Nair 9
signature " ease rea ompliance statement on back o-permit** Signature
Application Feels, — — /-� y-2 4 ,.1.z „��J
check#- _______�Issuing Date — ___. .
Expiration Date
NC Division of Coast:! Management
A
Cashiers i i 9 6 2 5
C D
Off c al Recei t
P
Date: �/µ°t�- . 2c .2e,
Received From- /2/41 re.e'C�L- 1,-- $ ‘-` " `
Permit No.: 7'es-7 L 7 Check No.: //y-2
Applicant's Name: 0-- "/'de-e-- County: /.(7 t'{--
Project Address: .2JS f, — /</ A,-e- 0'rCcv1 /!/ 2`? ,-
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
Signature of Field Representative: -1-_ - Date: A ' ‘5.94.2e1
0 LAMA / DREDGE & FILL No. 76053
G NERAL PERMIT Previous permit# , ;,4 �' C D
�
> 'VNew --iModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued .r/,i9
As authorized by the State of North Carolina, Department of Environmental Quality 7//
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 0 7/7c 72O# •
❑Rules attached.
Applicant Name f% p S /a:7,--i t_ Project Location: County /1,,.ele_ /
Address-ate f/i. c R ��/'/7/ /�o/1 f/4 treet Address/State Road/Lot#(s) 2J s /✓e,-L-c k
City Gain.-,fie— State/v CZIP ..2 745-r ,or,..,-._ n4/' ��'r•. 6c.n,,
Phone#Imo,?} -7V4-rereff E-Mail mc1.(4 5- vctcJ• w.^ Subdivision '/ /
Authorized Agent City OCi e c_�� 1' /4 ZIP oz7 76
Affected ❑CW ❑EW I rA ❑ES ❑PTS Phone# (- ) •
/ /River Basin c� �en
AEC(s): ❑0� ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body S-.4 L. .l` (nat /man /unkn)
PWS:
ORW: yes / no PNA yes /� Closest Maj.Wtr. Body �'C-^+ /� _
Type of Project/Activity Agi //, /. S ., /.2 •o. cCxi,,,) 4;ce N / n 77h 0,11
el aet-,J 7.t„ • '/C// O',-I'1 04 .rH i I /ae I Cr (Scale: / 6, )
Pier(dock)length
j 1 f
Fixed Platforms) , 4r,
f•t •`'�s Floating Platform(s) Ir kw 1 „II'
I
i ' 1
Finger pier(s) ����Vl�(
Groin length j 'Z( O Q` i
number ' -
Bulkhead/Riprap length o f
Z. j
avg distance offshore _,
max distance offshore Q G
Basin,channel + pd
cubic yards ' ! 1
Boat ramp 1
Boathouse/Boatlift 1 I
\ I
Beach Bulldozing
Otherivt I s/f) ywlL 1
a'6 " 17tc:w) - - .
Shoreline Length��� 1;
rie
SAV: not sure yes no ,_ ,_ i„,1 _ —.-- —'
y � ft,
,, 3 .�4 fMoratorium: n/a es `—, I �lsrp��r
Photos: yes If I • rI
Waiver Attached: yes no A building permit may be required by: 414— P See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) i/ � /' ��
Notes/Special Conditions c -�icn e/ S!r i'< <� / esT f c� '
SL e / $7 ' ,
Agent or Applicant Printed Name PermitOffi er's Printed Narr�
Signature **Please read compliance statement on back of permit** Signature
/3 V...2 a22/16 /O/,2-2-/�O
Application 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 Rullees Applicable To Your Project:
✓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 (252-946-648 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
CAMA / DREDGE & FILL No. 76053
GENERAL PERMIT Previous permit# ,v),� e °
)C 34New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -v,/I
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 ' '�" /-'-CV
,r� [I]Rules attached.
Applicant Name �./ /��CyN� G Project Location: County ///- �G /
Address-s : ye r r '-- /7/ J//� /�/•
f/Itreet Address/State Road/Lot#(s) .2J 5 ,ST/✓,- L i,
City ,�/ech,..1/c State /Vc(ZIP ..2 7f e--, rc ,/ `ram . G�.�.,
Phone# ( --.1/(-t: YS5 E-Mail PhJit.J -f$ ,/,„ , c.,, Subdivision Authorized Agent City Lie cr c le It///j,e ZIP a.?7 J‘6
Affected ElCW ❑EW is-PTA ❑ES ❑PTS Phone# ( ) River Basin /<.'/�r"
❑OEA ❑HHF ❑IH ❑UBA ❑N/A /
AEC(s): Adj.Wtr. Body �� L-c 4 (nat /man /unkn)
❑ PWS: /�'
ORW: yes /(no;) PNA Ai/
/(fit
Closest Maj.Wtr. Body '� �^ /a. _. o N., cl
Type of Project/Activity f/ci/ /%/,J s , %e� G ✓r�,;. relp< / .
C , � i if,/c i u l 0-r o,.--r j , t/i r ,,,,,,•1. r, (Scale: / 0' )
Pier(dock)length
Fixed Platform(s) r e t �5�1 r
Floating Platform(s) c�p'� Y� „ ,fib
Finger pier(s)
�
Groin length i --7( 77.CI \id, .
number : I
Bulkhead/Riprap length ' '
T
avg distance offshore ,
max distance offshore CO G ,
Basin,channel �,c'
t -
cubic yards_ —
i
Boat ramp �` I44
Boathouse/Boatlift
Beach Bulldozing
Other he e 1 /y0 /w/e
rt
Shoreline Length 'I -e f o °
',7
SAV: not sure yes no F -_-. . ..-.._—�f
--' —_-.
Moratorium: n/a yes m f 5 /1,.. ), r r�
, a
Photos: yes _ _ �f� �p��� i
Waiver Attached: yes no
i
A building permit may be required by: t 'See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)�/ // /
Notes/Special Conditions 441.1 v e/ _d.' , f ,per / 4/ /l A'�e J//a,
i
i
/ / /�
Agent or Applicant Printed Name Permit Officer's Printed Name
01..‹.€1.1„',.... r:7'r...„...4:e—,o
Signature **Please read compliance statement on back of permit** Signature
Application 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 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(910-796-7215)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 252-946-6481
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
a,,.r + ., r "^+rryS*'�,s7y..+w• .a+*"?:.'c+wa ,.�.+-..-raR�T'nwfi.,.oe.:-..... " '�'..-•,--,.-. ..', yq.-, x
4111 "LAMA/ DREDGE & FILL No. 76053 �
GENERAL PERMIT Previous permit# `,-` tD C
D
)C ' New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued v/'
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 •
❑Rules attached.
/ `'
Applicant Name . / , Project Location: County 1/ ,,-/,
Address ---— T //1 ///,/ r' / Street Address/State Road/Lot#(s) -,
City ! State V(ZIP '- 7
Phone#( ) • 9 '- E-Mail . !i Subdivision
Authorized Agent --•- --- City L /f -< ZIP .
Affected ❑CW DEW [l-PTA ❑ES ❑PTS Phone# (- ) River Basin / •, f ,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body / / - (nat /man /unkn)
PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body /.- I • , I
Type of Project/Activity , T r , ..�
- (Scale: / ' . )G• )
Pier(dock)length u +"
Fixed Platform(s) i t ,` 1.'t
Floating Platform(s) -Yr)' `— ( I
Finger pier(s) i 11 A
Groin length ' 4-�, '
ilf
number . ' I I
Bulkhead/Riprap length 1 \ f
avg distance offshore .___- ,.,Y....-.. i
I •
max distance offshore � 0Basin,channel f
1
cubic yards r j I 1 I.
I
Boat ramp A i
Boathouse/Boatlift
-- -- --- 1 , ,v 7 ' 1 I
Beach Bulldozing 1
,
Other ry, f/�.1./�. I -
1 L- /.- ,. , 0 ft. I i
Shoreline Length_ _
SAV: not sure yes no : ---- _-._ _-._ ^_ I _
Moratorium: n/a yes no r p * f_
Photos: yes no Ix I t I r` ', .-li x
is
Waiver Attached: yes no , J
A building permit may be required by: At / "See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) /
Notes/Special Conditions / /i" �/ �>
Agent or Applicant Printed Name Permit Officer's Printed Name
I Signature **Please read compliance statement on back of permit** Signature
C I
I - /, /
Application 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 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(910-796-7215)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 252-946-6481
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
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l" k t ii 5 t" -al i e J . 's
(Name of Property Owner)
property located at �3 5 $.1 L.v e A Let ice_ cLc .
(Address, Lot, Block, Road, etc.)
on .`jt►veR, LAkQ. , in QiAA Cck e . /\IC, , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
``_ (Individual proposing develooment must fin in/iocrrintion below or attach a site drawing)
Yr, £r 7
p:1409 s
n I a 1 C-s � C I.:?r, it ., '�'. .5 t
O �:;.;,
` :` ? P,l,,.“; Wrifl c gi n;;- Q a
tz t c s,. 4: .;
4.\ .;1. q T ft. ,,,, �i IP ;1 .. c
-
M • L` ti_i Le r.q+�:
tv u
i t J l e R ..rl A-! ` r
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
V/ I do not wish to waive the 15' setback requirement. (u 13)
(Pro/perty Owner Inn/�fformation) (Adjacent/
Owner Info/rmation)
iC
2------ c-1)
Signal ut'e !! ig tore el I e c e
pl
Print or type Name Prin r pe N
/7/ ifairy hri//s• Ai 2 - I rI/ tk.y
Mailing Address M�{tir Address t.—
CFoen//rll& . /V' (2-7$.g M i V Ast_a_4olis (VL)`1 s > 4+I4
City/State/Zip CV/SZte/fe -,a 0321 c(G God}„hip,
:ZS3. 3.71 `l 39 5- yyty s -iC. 53 ✓�to-e`,,, (4, LL
Telephone Number/email address Telephon Num er/email address +0+4,ho441 4i• M
S2 3y/ `1885 , /I 3 j2.°ZD
Date Dale*
(Revised Aug. 2014)
*Valid for one calendar year after signature*
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Phiho S,
(Name of Property Owner)
property located at 3 S Stl ve rz GAl,CG 1 ,
(Address, Lot, Block, Road, etc.)
on .S1"1,;zil , in doR cir cc Ki NC. , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual nronnsinri deveionment must fill in deserint - or attach a site drawing)
�II a l ;_E ! =— FLAIurst. T>Rn'_:rc i i s SCol
tr;
7-7 { ' P11'44, c AoTPcEn-- '}o +�rr • y
{c�Ct s' tivG 1L--(� tIL ��
1
3 t
1� fw
1
rV
a3s
2., 1 4-k
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. er
(Property Owner Information) (Adjacent Property information)
��u ' tau
S
f . c�, -_
Signature Signature'`
l A 1 1! ) S toe_a ce Lit✓ -T
Print or Type Name Point or Type Name ' —1
i -�f r //y /—//- R� O y
Mailing Address MMiling,A dress,/
� res,A.;vl((� j / C :� 7 '2 /�G� c: J C� C-
City/State/Zip City/Sta ip •21 c1 ea C C, � -�
Telephone Number/email address Telephone Number/email address
Date Date*I1 \ • da a a
(Revised Aug. 2014)
*Valid for one calendar year after signature*
Sparks, Keri E
From: Sparks, Keri E
Sent: Tuesday, June 23, 2020 9:11 AM
To: muslig58@yahoo.com
Subject: CAMA General Permit
Attachments: No. 76053 Purdue.pdf; 07h.1200.pdf
Good Morning,
Attached is your CAMA General Permit No. 76053,receipt and rules. Please sign the permit and e-mail back to me. If you
have any questions please contact me, my information is listed below.
Thanks
Keri E. Sparks
Q
NOT-CAFCLNA Jf' NC Department of Environmental Quality
Department of Fnvfoo nonfat Malay Office:252-948-3820
keri_sparksP ncdenr_eov
Email correspondence to and from this address is subject to the North Carolina Public Records Low and
may be disclosed to third parties.
1
NC Division of Ccastai Mgt.. Habitat Impact Computer She&
Applicant: �'`'`/7/, / Cc�
Date: 6 /y D`- 2
General Permit#: 7‘. O $ J' /3
Describe below the HABITAT disturbances for the application. Ail values should match he name,and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet ANAL Feet
(Applied for. (Anticipatedfilal (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance Disturbance . disturbance.
Habitat Name includes any Excludes an► total includes Excludes any
Choose One
anticipated restoration any anticipated restoration and/or
restoration or and/or fetap restoration or temp impact
temp impacts) impact am oat) temp impacts) amount)
QQe'►2 e/4 T Dredge❑ Fill❑ Both ❑ Other 127- (J ( ! 6
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
•
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
•
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ •
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill.❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
• Dredge❑ Fill❑ Both ❑ Other ❑ •