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HomeMy WebLinkAbout76087_Cam Vandemere Inc._20200803 2 3 NrCAMA/ ❑DREDGE & FILL (P(PLO q (t0 No. 76087 GENERAL PERMIT Previous A ® C D permit# /�/t" 1New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued /VA As authorized by the State of North Carolina,Department of Environmental Quality / /ZO and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 7/7r P V Q� Rules attached. Applicant Name G .- dit,v►.v�,,r.c , �r•c Project Location: County �f( E) Address 24 1-1.4.r27k ' > r . Street Address/State Road/Lot#(s)7/5 7 (roe s4-1 City Vow-o4-r►•i--'-L State dJc ZIP-t$V 7 Phone#Mz-) 45-9 3 X E-Mail Xt e '6/04"-2 l'( - Subdivision Authorized Agent ez Z O c City Vo"^•9 -- ZIP ZS s,7 Affected O CVv AW XPTA ❑ES D PTS Phone# (Z )5 Si? '87d River Basin ( -- 5 : 0 OEA D HHF ❑IH 0 UBA ❑N/A AEC(s): Adj.Wtr.Body (nat 6/tinier)) O PWS: ORW: yes / o) PNA yes / no Closest Maj.Wtr.Body Frr7 a/-r'r Type of Project/Activity i4j4 ca.�-I Rodoos-ciff pd J ) -.2, V ' Floe ky.,> (c- lounr�1, (Scale: /.f3,2 ) Pier(dock)length (y I Fixed Platform(s) �-, E._ -_ .._._j o'_ 4 ' T I 1-,_- __. _ i i FloatingPlatform(s) Finger s aiiii" ��M >;e pier(s) _— t' ' - ..-_ .. `-''It Groin length I �iirc.,�. C number1 II Bulkhead/Riprap length --tLj __ _vtanceore — max distance offshore + --- .__ _. _ .__—�—__ Basin,channel _[ ' �� �(- 1 cubic yards- ---4- I - Boat ramp _-.J 0 Boathouse/Boatlirt {. ._i I. j — i . . �. fro - _ QuAtak Beach Bulldozing : r__ : �� i _. lifill Oft: 141C� ,j (f Y A _____ ___f_i_ < j ye, ' Shoreline Length- Zen - -� --_ 1e + SAY: yes no ; i. .. t'IS t. 'A `P - - Moratoriumn/a yes j , r� _ _ Photos: -cy - ---- -n � � • Waiver Attached: yes I I ' I��I -, A building permit may be required by: �.Gn/ C.��G4 [ Sea note on back regarding River Basin rules. (Note Local Planning Jurisdiction) y Notes/Special Conditions ( ( (p '' ,y(_ Q(ecA^')n "p P 0.tJ l 9 ^3 y•e,.>u.(.L./'--eyw( no ,_. 1 A/ or t Printed N Per it•ffic: 's I); olcure *II' +ad compliance statement on back of permit 5 SO/� Ar7e)--c-' ;77 3-2 , 3- 2.2:12.o Application Fee(s) Check# Issuing Date Expiration Date 1 • AMA / DREDGE & FILL No. 76087 A C D GENERAL PERMIT Previous permit# /l/4- C) New -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued w4" As authorized by the State of North Carolina,Department of Environmental Quality /ZOv and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7/ . KRules attached. Co Applicant Name 4-,p Vol v,or.�p �c,r .c• ,�,c-• Project Location: County r r) Address 7� I ' Srr • Street Address/State Road/Lot#(s),Z/5 T7,r rd s- City Vow,o9-1--64,-&-cL State ode ZIP Z$S17 ------- Phone#(252-) '9 387( E-Mail XfA ' Ame''"""2('C`""- Subdivision Authorized Agent E`Z 7:)&cic City Vo^^^p — ZIP ZS Affected ❑CW Aw %PTA ❑ES IDPTS Phone# (2 z S)S '4l 5874 River Basin j\f« - AEC(s): ❑oEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat ma) /unkn) ❑ PWS: ORW: yes / Co PNA yes / no Closest Maj.Wtr. Body Q/`r-'- Type of Project/Activity 4P//, c 1 Porvs-c_i 4 J I )D e-, ( ) flo•4-4 I'ce.y <<- tow.,^c5-. (Scale: /,'3(.9 ) Pier(dock)length 67 - ____ Fixed Platform(s) 25 ' . I 4;tS 1 , ' Floating Pl tf rm s o.d � ? Finaer ier s ! 'ro — (.! Groin length �� number �/ y; yc ' 4 k v� _ �{ Mn_ 7,-op Bulkhead/Riprap length �1 ' 1(\ 1 V»' VY �� ik avg distance offshore V max distance offshore �l Basin,channel cubic yards Boat ramp6 D Boathouse/Boatlift r d�� — _...... -..----------- - i-- 'T ‘, o Beach Bulldozing f Other ff 1�1 3(I ' "/ma[Tc'y W1 Ai IrDL , ` j - TAM Shoreline Length -I-ZpU c' i { SAV: liii° yes no `D Moratorium: n/a yes GOY�� Photos: yes k✓44.r- Waiver Attached: yes p --- --1- . 1 i A building permit may be required by: c... © See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) H1 Notes/Special Conditions I N (o cy�-- Q - R el j — j I . 3 f'w C. 6-( AO d� -.CCe. ti L /�vrd a F- Ccr..��,.Q _ -e.,r1/44- . . A J Agent or Applicant Printed Name Per itOffic�-'s P ' ted i . - IP Signature **P e read compliance statement on back of permit** Si: p2uOe)-5—' - 77 I.. - - . 3-2oT� �, 3- �/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 Rules Applicable To Your Project: I I 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 (252-946-648I) or the Wilmington Regional Office(9 I 0-796-72 15)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 40 I 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 0:II CAMA/ ❑DREDGE & FILL No. 76087 A BCD GENERAL PERMIT Previous permit# >Z EINew ❑Modification ❑Complete Reissue ❑Partial 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 SA NCAC . Rules attached. Applicant Name (',- t' V c c(-c.,,,c___- -, T ^c Project Location: County Li,, . I i c, Address. 7- T Gar( Street Address/State Road/Lot#(s);_'%`; 17, City , c.'- , C State x_-`C ZIP — 2 i .7/.,: , Phone#(2'5 -) 7-`--> '.')7C E-Mail /",,-// /` Subdivision Authorized Agent e2 D`c j` City V c' ( " `L- ' ZIP Z-_-- —' ❑CW XEW IXPTA ❑ES ❑PTS Phone# ( 7'z)c. E -> ' River Basin N c-,--5C Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A AEC(s): Adj.Wtr. Body ,•--- ( (nat/man /unkn) ❑ PWS: PNA yes /(no Closest Maj.Wtr. Body / ' / , ORW: yes / no Type of Project/Activity /afp/' if l', (Scale: ' ) Pier(dock)length & X / 3J �' r' I Fixed Platform(s) V f Floating Platform(s) / -it... . yX 3' f ,..,G b fg�.I�L - I �p Finger pier(s) 'L" I)/G (Pe)- ` it ' I ` (e Groin length V �' l raj, vie number Bulkhead/Riprap length \-,� b- (. ' I avg distance offshore ~^` j max distance offshore 1 �' Basin,channel (.,-.,C �f , V, �4r Ir� `I^ v(� cubic yards / ' ! - 1 y Boat ramp li' C I t Boathouse/Boatlift i c )t:'�� -i . Beach Bulldozing C 1.,1� —.. { fALA!,' } �i f/ N� i ► �/ ���/ V J te �� Other L--__ ' G,y .,. f l" \, 4 ' } tit Vl I t r Shoreline Length -- ZOD U I ) ..—, ,f,i,� SAV: not sure yes no 1 t r, {.- J ._ }'a^ 1 / • �,/ Moratorium: n/a yes no �&��k',,,,r7 r(ap Photos: yes no-) 1319 i i-t. � � t Waiver Attached: yes ,I ? �r>..I 1 A building permit may be required by: ! • . - . See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) / ji Notes/Special Conditions I ( (0 4 { ' ; ( ( ,, ., — j r; , )e(CC //cJ {,.,,l1(I de r'c.,-,a..Q Agent or Applicant Printed Name Permit Officer's friKted e i Signature **Please read compliance statement on back of permit** Signatur 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 252-946-648 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.or dcm-home g/web/cm/ Revised 7/06/17 �CAMA/ E. DREDGE & FILL No. 76087 A BCD Apt, PERMIT Previous permit# )C -,New Modification ❑Complete Reissue ❑Partial 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 . ❑Rules attached. Applicant Name Project Location: County Address Street Address/State Road/Lot#(s) City State ZIP Phone#( ) E-Mail Subdivision --- - Authorized Agent may- City ZIP Affected ❑Cw N'EW PTA ❑ES ❑PTS Phone# ( ) River Basin 10 AEC(s): OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj.Wtr. Body Type of Project/Activity (Scale: / ) Pier(dock)length , r• I Fixed Platform(s) I t,-, 1 Floating Platform(s) • i I - Finger pier(s) ,/yam- i , 1 j , Groin length ` number ' Bulkhead/Riprap length avg distance offshore t 1 i max distance offshore Basin,channel ) • . • �� _./ cubic yards / } ! \ �L Boat ramp i Boathouse/Boatlift I j1 \ ____ . . —_ s i, . Beach Bulldozing - 1 ' 'Other _ :- ,L. �� t \ j i 41 • Shoreline Length - f-cr.; 1 SAV: not sure yes no -----''- -7-,..f' -.-- ._____ _ . - — ,-- Moratorium: n/a Y es no 1' I Photos: yes no T t, 1 Waiver Attached: yes no `�� -J A building permit may be required by: . U See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions - Agent or Applicant Printed Name Permit Officer's Printed Name • 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 7 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(9 I 0-796-72 1 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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION �y Name of Property Owner Requesting Permit: l -_CI P(1V10aet A.e./ne:r -1-�J6 Mailing Address: _ 0 *g 5 rt Q &,ine{`e__ it C. a 8 S5 9 Phone Number: a-b 5 - 2gr(4, Email Address: n G fl ti r-e11 - L- hc14-(NcA d C c m I certify that I have authorized L= Z £' )C-k clinVirl RA)Cif:rSC)%0 , Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: c'1•10(1-*--i\ r (-\ Vc-tr-it< \ itujk :� ,s "'in at my property located at ;o E 1 [m, 4-J VI.I4 AT, ; ? ac\„\kkec.)in County. If furthermore certif y that a 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: C . Sign ure Print or Type Name ON2C1r Title Date This certification is valid through / / I /Dock Live Load of 62.5 Ibs/sgft MADE IN \ Low Profile Dock Live Load 30 lbs/sqft - 9r-9" USA 91OOC K' \ / I ij q 0 1 1 1 1 1 1 I I 1 11 L q G 0 0 00 0 0 14' 1 q Co 0 00 0 0 I I I I 7 1 I I I I (Project Name: N a C ,NC DO w� Distributor Name: 1 / W W�// David Anderson C) (-) C) EZDock Solutions (252)773-0793 xerylP". • /) \ Drawn by:David Anderson .46 Dat 2 DWG Name:000_43991379725 EZ Dock,Inc 878 East Highway 60 ',, Monett,Missouri 65708 Phone:1(800)654-8168 51/6-7/f( ' ,( ( Fax:(417)235-2232 2232 r � Wt di� "- General Notes: I. This det ng does ot reflect anchori conc.Once sufficienteand information& r completed Proposal Request Form concerning water end bottom conditions / /, A is received,anchoring may be detailed. l,v/ 111"`";J;;J 2. Note:It is the dock owner/operator's responsibility to ascertain and comply with all applicable Federal.State,and local laws,ordinances and regulations,as well as all inspection,permitting and licensing requirements pertaining to the installation,application and use of EZ Dock products on the owner/operator's premises.EZ Dock,Inc.assumes no duty or responsibility with respect to the legality or compliancy of the 1. owner/operator's chosen installation,application or use of EZ Dock NOTICE!Read EZ Dock Limited Warranty carefully. Among other things,EZ Dock does not warrant damages, products failures or defects caused by unauthorized modification of EZ Dock Product,and/or unauthorized attachment to/of EZ Dock Product. ,3. Reference EZ Dock Owner Manual for additional details. Dock Live Load of 62.5 lbs/sqft MADE IN Low Profile Dock Live Load 301bs/sgft USA U U q C;l� I l t l t t t 1 1 D3 as o D3 14' o 0 o a D3 1 f l I I D3 41111111111141 "Project Name: pc> CQ� ,NC Distributor Name: David Anderson EZ Dock Solutions (252)773-0793 • • Drawn by:David Anderson Date:7/27/2020 DWG Name:000_43991379725 EZ Dock,Inc 878 East Highway 60 Monett,Missouri 65708 Phone:1(800)654-8168 \Fax:(417)235-2232 General Notes: I. This drawing does not reflect anchoring.Once sufficient information& completed Proposal Request Form concerning water and bottom conditions is received,anchoring may be detailed. 2. Note:It is the dock owner/operator's responsibility to ascertain and comply with all applicable Federal,State,and local laws,ordinances and regulations,as well as all inspection,permitting and licensing requirements pertaining to the installation,application and use of EZ Dock products on the owner/operators premises.EZ Dock,Inc.assumes no duty or responsibility with respect to the legality or compliancy of the NOTICE!Read EZ Dock Limited Warranty carefully.Among other things,EZ Dock does not warrant damages, \ owner/operator's Ptt chosen installation,application or use of EZ Dock ts. failures or defects caused by unauthorized modification of EZ Dock Product,and/or unauthorized attachment to/of EZ Dock Product. 3. Reference EZ Dock Owner Manual for additional details. � \ CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: ;(L NINNA Me_r ' \c c Address of Property. 215 •Alva %c - vrty16rXveye k`C, rg$mr) (Lot or Street#, Street or Road, City &County) Agent's Name#: Mailing Address: Agent's phone#: • 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. f47, I have no objections to this proposal. I have objections to this proposal. if you have objections to what is being proposed,you must notify the Division of Coastal Management (DCM in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at http://www.nccoastalmanagement.net/web/cm/staff-listinc or by calling 1-888-4RCOAS T. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION 1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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. R I do not wish to waive the 15' setback requirement. (Pr: . Owner Information) (Riparian Propertyrnerr IIn ormation) —e�s�so / Al y _ Signature •� , Print or Name i• or Type Name �, 9-c i 355 -?. . e7,0•:. 2 Mailing Address Mailing Address VaMerocce I3c_ cRc 2tci g City/State/Zip City/State/Zip Telephone Number/Email Address Telephone Number/Email Address V A.op \1 .. )3i G 't V24> Date Date (Revised Aug. 2014) i SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1,2,and 3. A. Sign-.• - A / Q'Agertt • Print your name and address on the reverse / . ❑Addressee so that we can return the card to you. IIrffirAttach this card to the back of the mailpiece, by(Prfhte•Name C. ll- of Dr ivery ' 0 ; G l5 .• or on the front if space permits. / � / 1. Article Addressed to: D. Is del address different fro item 1' 0 Y- C,cyl � t/ll eS JC V ' If YE',enter delivery address below: 0 No ty ;9 i$%�J�— I�C,wrat tiLag5t5 II I IIII'I I'll lIl 1111 IllIlIl l l ii I Ili I II I 3. Service Type 0 Adult Signature a 0 Priority Mail Exppress® ❑Registered i rAdult Signature Restricted Delivery 0 Registered Mail Restricted Certified Mail® DeMverYY ;. 9590 9402 4999 9063 5249 05 ❑Certified Mail Restricted Delivery 0 ReturnAcce:p for Collect on Delivery Merchandise ❑Collect on Delivery Restricted Delivery ❑Signature Confinnat n rm 2• -.-._•4.��`? from service 1060 ❑Insured Mail ❑Signature Contr^nstion 7 019 0160 0000 2869 14 31 "estricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt 1 SENDER: COMPLETE THIS SECTION COMPLETE THIS.SECTION ON DELIVERY • Complete items 1,2,and 3. A. Signature II Print your name and address on the reverse d � j` -eit `� CI Agent so that we can return the card to you. X �Z. ❑Addressee ■ Attach this card to the back of the mailplece, B. Received by(Printed Name) C. Date• Def-ery or on the front if space permits. /� 1. Article Addressed to: . J • O _ D. Is delivery address different from item 1• 0 - C, % ter 1 r, D If YES,enter delivery address below: No , )q%o d 'Pet,33\na4ei \ ,vc,, A t.Y) III'lll'I I'll I'I I Ill IIIIIIIII I II IIIIII1III I III 3.❑Adue lt Signatuice re Restricted Delivery 0 RregisteMail Express@ ered Mail R tes ricted 9590 9402 4999 9063 5248 99 — lied Mall® peavery 0 Certified Mail Restricted Delivery 0 Return Receipt for 0 Collect on Delivery Merchandise 7 019 016 0 0000 2869 1448 --riled on Delivery Restricted Delivery 0 Signature Confirmation 4. red Mail wed Mail Restricted Delivery Restricted Delivery I lover$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt i4C Division of Coastal Mgt., Habitat Impact Corrmpuier Sileaq Applicant: aonA.ED V 'e''� Date: J4 LA.cl , 3i 2 6 2v 3eneral oerrnit#: ?,O eescrbe belew:he'HABITAT disturbances or:he application. All values should match he lame,and units of measurement found in your Habitat code sheet TOTAL Sq. F ' FINAL Sq. `t. TOTAL Feet ANAL Feet ;Applied or Anucioatedraal Apolied or 'Artictpated that DISTURB TYPE Disturbance total :istutbarce. Disturbance disturbance. :Habitat Name Choose One ncludes any Excludes :ry :coal rciudes Excludes any anticipated -estoratiar any anticipated restoration and/or restoration or and/or amp -estoratien.or :emp impact :emp.mpacts mpactancunt" :emp`mpacts) amount) C Dredge] Fill Both Other, i is 4 recce F',11 Both Other • Dredge 7 ill Both J Other 12 redge J Fiil J Beth 7 Other Dredge � Fill Both ether Dredge Fiil Both _ Other "1 • Orecge =II= 3cch 7 Dther Dredge F 11 2 Both. 7_1 Other 7 serge= F'.ii 2 Both Other i Dredge F:11 Beth 7 Other Dredge� F it Both Other _ Dredge_ =II_ Bcth 7 Other ecge ell Both Dther redge Bete Meer