HomeMy WebLinkAbout77245_John n. Jorden_20200908 RriCAMA,/ n DREDGE & FILL
ci"1
9,ENERAL PERMIT
Previous permit# C D
PINew L3 Modification i ]Complete Reissue I'Partial Reissue N(' 77245
1
wAyA
Date previous permit issi ed f
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 31-1
tignuiss attached.
Applicant Name .,-..)0M k'I. i-7)0C.. dsi-rs Project Location: County_geaLk Vb Y"k
Address 5(12, __,5 vap__,ill La 11)1 11t.. Street Address/State Road/Lot#(s) 5111- Sevu.x 0-c, .1
City_b_Ok. _ State VA C- Z112 1.Scii$ -LA.T-Nbii_N-' ---
Pheine#(2'..J_F:)_41.16_75?_;_+. ... E-Mail.y=4*Lra yelp"gyabIPrn Subdivision trAVI*CI
Authorized Agent NI City__&-AAA"
(SEW (hA DES OPTS Phone# (?-51)4%-5.215 River Basin'7AR /P4 ill
Affected
0 0EA 0 HIV 0 IH CI USA 0 Nifs
AEC(s): Adj.Wtr.Body _LetW ell man/unkn)
0 PWS:
Body_ _CityAit.)„,
ORW: yes /C > Pt4A Closest Maj.Wtr.
nol*".11-
Type of Project/Activity?raft.%e' eci,1,cfri.4 G40,4 tp Q 38'A 19 i ',.)e/ Iv/ 12: A 20 4 -14 ellb
l
7 iie4-co1Y, itlif Y'A )3,' 5 kp, c:....1-, FL ,-„,-y‘ (Scale: I/1-3c.° )
Fier(dock)length 3$'
axed Platfonn(s) /2:$ 2-0' --- -: ! 1--- i ' I !
___ :‘, .... 11_1:T '8•,-... :
Floating Platform(s) .
Ricer pierw 't.. I. -5, '''- ' - * —- - '' • - ----- I ----1---- - i I --I-
-_i_ ' _ .. _ __L t_ 1 . ._ H_ _ iiii, ' _4_1
I Ir
Groin length i 'i
number I : - I I __ AO A, 1 I 1_1_1 l
Bulkhead/Riprap length _l__1__ _:,.. __I__ 11_ _ L . ?_ _ .I_ i___,_ i, _I. _ ___ 1 -_ ! ,
_Ally ..41,if ... ..1-.. .., 1... . ...,, ... ii. , i
avg distance offshore I .
_i_1_1.
MU distance offshore ; 1 I- ''‘'..rn --r- -- -- ' 1 1
- — ,
Basin,channei _f_ . _ . ' I_ i_. _: ; __1_
, ! _I_
cubic yards -: ---11-1"-• - 14 ---- - i 1
! i
I_
- --!-- --t- - --
Boat ramp _ 1 • i
i i V
Boathouse/Boat& _ it -- -- - --I - „— -1---
-iI'----_ —:• ..
:4--- -
i 1
_
Beahudoing -- - - - 7 i OtherGPipi" r_ _ _1 . . . _ ---_ ---1
7i _
De tif di (AcerSiet 1 -- . 1 I-.--- --4- - -
i..__ '
'11111111i111•10 .. MIIMIbarre;.. a .ii ----- - ' -- 1411_,
SAM 401M- Yes filt - ' • 1' 1 - -1 1 ,L! f i 1 , lit
Moratorium: nia yes 6;) t1110.--- 1 I 41) 1 , _ ._,. _ 0," 4 1__
, , Limo IA 1 ri, .. ,,,,41 1
Photos: Yes a -TV-17r
1--1- 1 -1-•• • 1:-]
. 1 ___L '1, 1 •_.1
Waller Attached: yes ,
A budding permit may be required by 13 VALA cs t NUYiki . Itsie note on back regarding River Basin rules.
(Note Local Nanning jurisdictioa),
Notes/Special Conditions rl-EIL ItYlu..C‘"" S rj 4._ 0., gra,;v•t%nelt,Yes. 0 g- 3101‘ Ou'e-r
t..04/fitt vic. taill$ , 1161-1Nta,,,,,,,,,r 'Ns Goi''Nel 5.2.1) 41'. 0 c" 4)/te:1 r 4(I
itx> f-F
0,114/ N, T 040/IL/I/ A/76 1-1,,z_ 5piyes-7
Aterft or 12t)' il
Muted Pe it er s RriTsted Name ,
C3' **Please r pliance statement on b of permit" Si_ginar 11( e‘itit ° ack
Application Fee(s) Check# Issuing Date Expiration Date
I
1
?CAMA,/ E DREDGE & FILL 09 N ERAL PERMIT N°. 77245 A In D
C L Previous permit# N
) New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit iss�ed sll A
As authorized by the State of North Carolina,Department of Environmental Quality I,Z`f�and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC f
"YrRules attached.
Applicant Name c0AO 13 Jor \c�•Y-N Project Location: County AVt;r*
Address 5 1 Z Sat" t I r'aYl.) 1 Pi., Street Address/State Road/Lot#(s) 94Z- $‘1,4..A.4 c - 0
City boy .1 CState 1 ZIP Xl-0 95$ �YN k v� _ I
Phone#(752) 147j5-S2-15 E-Mail yok,Ya1:04.4.r, eCyahoo.CoM Subdivision 51.1vvrV I LQr)1v19
Authorized Agent 0i / ✓ City &a1` ZIP ) S0�
Affected IICW Q EW I ? A ❑ES ❑PTS Phone# (15 Z) &4% -5"L 5 River Basin T}R i ? m
AEC(s): E OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body }la'(vel CrQeK 40/man /unkn)
❑ PWS:
�0lari. Closest Maj.Wtr. Body PQr h\i.cr> gl St.-
ORW: yes / no PNA 69 no
Type of Project/Activity ?'-s e. eo✓strut- 0�► v 38' A /,,,' p i e,/'' hi/ /2' A 201 L -/4 rib
T(a+tppDrry� ,.„,t- '/'A l i f 5 kp c-..w1, ,14 \' '-vr' (Scale: I"-3c-, )
Pier(dock)length SBA
Fixed Platform(s) /Z.'1( 2_0c 1 14.0.Y-V1est Crte.,\C`
Floating Platform(s) I
Finger pier(s) (Z 1111 .,q __...._
i
Isj ,
Groin length i fi0 i
number ,_........_-._.._..- i \____
--
Bulkhead/Riprap length - — -"-`. q0
avg distance offshore I I
max distance offshore ' ' i I-�" I
Basin,channel I f ' + f i
cubic yards_ f I ! ng"C A 42�
Boat ramp { I ^ y/`i �I +`V Qo
1 4.
Boathouse/Boatlift — 1 _._..._._..........._._.-�...... `_._..._— _ _.._..._.._..__
i
1
Beach Bulldozing
ingc � —
Other l�)( d pi i 'lip�� 70,,sot`"tts
ouc' CPe.571� j i .�1� •
Q
Shoreline Length - I go' l � i � '�� _� �� �`
Lod A
'P_ o
SAV: yes ® I — _ 1 e
1 _ N'
Moratorium: n/a yes (� � '- j(j
Photos: yes 26.) — —
Waiver Attached: yes io I l
A building permit may be required by: 15eat AlbDt C&C V . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction it
Notes/Special Conditions T‘Ell- NMuS Nj t a it6 nelWA"- O c" Dlo pUt-r
CQ4F rll wc dell S , ‘korr._oc.,nn.r ;S ( $1-.y . 2a 01" c' - 4\r 4((c.4...�J
55 bc) Er-
/ C i./! 5P)vei
Agent or Applicant Printed Name Pe itO cer's Printed Name
'
Signature **Please read compliance statement on back of permit** Signa re
CAW ' . 4Z6).re'. 1041 `i g f o / /2—e,2./
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 I 1 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 910-796-72I5
252-264-3901 Fax: 9 I 0-395-3964
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
e
OCAMA / ❑DREDGE & FILL N° 77245 A a C D
GENERAL
PERMIT Previous permit# 1,1A
>�—% Al Modification Complete Reissue ❑Partial Reissue Date previous permit ised N 4
As authorized by the State of North Carolina,Department of Environmental Quality ����.�cc�
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC -4 N . 12-`/Ip iz .
�" �_ iZfules attached.
Applicant Name S ► O k , ,�p.r ur•-‘ Project Location: County ,,'.Qr - c
Address 5y 2- Sat ry,I (I LD f1 V ‘tin Street Address/State Road/Lot#(s) cj L••/Z ,t,,,•0.;,0City ?jok'\ State U C ZIP Xl-c59:5S • , YJ, v`•
Phone#(252) 1-175-5215 E-Mail ) •+ .\ •--.- • f•^ Subdivision AW'MA LQr)\vNt)
Authorized Agent 01- City -6a ZIP a.4 UOO
Affected [ CW ❑EW T/TA ❑ES ❑PTS Phone# (?5 2) Lich-523'S River Basin Tp R / P 4 m
AEC(s): ❑OEA ElHHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body ! /man /unkn)
❑ PWS:
�
0lor> Closest Maj.Wtr. Body F lry a e-IUer`
ORW: yes /(rib • PNA es no
Type of Project/Activity ' , • ; .ti ,S i.-rN c)-7 o,, o G + ki 1 7' A 2Q' Z. - i-I 01 I'
iP 1 i. k1 r/r fv, 1-, y ' i( 12 ' 5 tC7 cc:,.......v, p 1, 1 ,./Y-N e: j"_ 3o" )
Pier(dock)length 3%/ _ '
Fixed Platform(s) 1 2- f ZV' ' I 1. i ,v4% Ce t•t=k 1 - -
Finger pier(s) ! 141/4
._._.—._.._. _... I
Floating Platform(s) - I I I --_._._........... _._ y -..----- '-- —.-
Z I i
g P O
Groin length i ! ) �
i
number - - — .__ - I. _ _
' `
Bulkhead/Riprap length — - �Qa *t�
avg distance offshore "k 1A '
max distance offshore i
Basin,channel j k 1 I
cubic yards ! ? ��f�I
19°1 xti le 1
Boat ramp + 1 T
Boathouse/Boatlift ,..._._....._; - 1 4 --
O
Beach Bulldozing 1 S' -
Other FY J / --)i- Sty .1;, ``1
v e/ trc. , 1 I 1�GY , as ,,r' 43'o' \T�
el
Shoreline Length l �� 1 ) (. --*1— �1..' l
I A
_ __ n
SAV: �� yes ® l i� � d((�, _ c o� `��! ''
TOP-? .
a
Moratorium: n/a yes ® t- • •- ;
Photos: yes - ..., —_..._— _. _ .... 1 1. ...._ $'�' -_" ._........ --+ j
Waiver Attached: yes io
A building permit may be required by: 1:3Q(,1u-Poi l Cal See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions S Em r.v r .t\' tiJ e- a re:.v. •lel 1... Ca 36� hu'r
5 . Norr.<ea.-,�- \ S u01^y 320 CO- o C -41,ACNr a II ..,.-`-
/GLy 3P1yt-i
Agent or Applicant Printed Name PermitO, er s Printed Name 0
Signature **Please read compliance statement on back of permit** Signature.\1‘ 'C'() nt)t)' ' /04c.1 1/r /.20,2_, i y /2.4b 2./
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/ 1-888-4RCOAST 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
0 ICAMA / II DREDGE & FILL N° 77245 A 1) C D
GENERAL PERMIT Previous permit# NliA
�—•DN ❑New ..-Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N AAs authorized by the State of North Carolina,Department of Environmental Quality 12 � !
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
E2fules attached.
Applicant Name 4' ' ±y, , c:.,' ,,, Project Location: County ?> , !-
Address 5 `t -• -? ;",r-1 i f L') .'t' ` :NOS Street Address/State Road/Lot#(s) Gj L/Z . 4,,,. 0,, I
City i-')c,,.Or, State LI C ZIP - -+4 05,, • ,
Phone#( - ) `( it;-',7.14) E-Mail 1
Subdivision W r ' :al' t v-41
Authorized Agent 1 if City �:� \ ZIP3`>�ciS
2CW ❑EW I3P//TA ❑ES ❑PTS Phone# ( ) !lc -S Z3-5 River Basin i4 R / Pa m
Affected
AEC(s): ❑o�► ❑HHF ❑IH El UBA ❑N/A Adj.Wtr. Body (fiat"man /unkn)
❑ PWS: ._.
•
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body Pc=i rn,'c I `, t^
Type of Project/Activity •1 x L(-' Z. - I-j c;+,)
I. _ 4. V: '„ 30.' )
Pier(dock)length 5%' _
Fixed Platform(s) /n f 2.it:-/ { ( Zc
i I
{
Floating Platform(s) ;
Finger pier(s) i{ Z.-' — I N`` j. I—
Groin length ' 1 toy
number -- 1._ _... —.— __.: .
I
�• 1
Bulkhead/Riprap length ` *_._- C _ ,___.. w-_.i.. ---- — .__ ._.
�t Pc f ,�1
avg distance offshore \ _ j i r at'i Jt^ j
max distance offshore ' Ni ! !I
Basin,channel �j I, , I
cubic yards I i I I ,,ram
Boat ramp IQs' ,1` 1 I
' 1 I �} '
Boathouse/Boatlift -'-- -- i - � -- —� - ---
I _ T
Beach Bulldozing ( ' — it"'*\it' `.'P---I 4-- -- —_—
fa
Other }
I
-oil 4 W . s ‘P. 111
j I iska,,l
r
Shoreline Length J� ?�� ��i y A
SAV: ;, not sure- yes i �•{�} ( __...-.... _ ��`-0-1 - -- -N --
Moratorium: n/a yes ,*: 'f a� rt
r
Photos: yes no rVTL- + —^, -- ----i — 4--.._ _...
Waiver Attached: yes io� I i , f
A building permit may be required by: ',9;,t'EC)t- 'r 1,, 4. j•n"'t N) . I ...See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
i
Notes/Special Conditions ' i_72. 'v"u V' \')r a h•:•., v c..,V1 t.,, . ,t,
. _A-4A-y 3-2 0 �2
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature **Please read compliance statement on back of permit** Signatures -"`
f
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:
V Tar-Pamlico River Basin Buffer Rules I 1 Other:
I 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(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 910-796-72I5
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 T0/a1V ->"-644-0/91✓ 's
(Name of Property Owner) ,
property located at 5 y.- J4 4J,/vl/L- I-4,12/Na gi j%' /A/t, .37f $'
(Address, Lot, Block, Road etc.)
on 1 A/W/V C'iZh C , in ,J471) , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. •
`-S) `-l' 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 de crip#icn below or atlacit a site drawing)
•
Po C!z- Ii/ \ Pilie,t
•
I -
o Ito Ai— ��++�. n�- . \
WAtVER 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.
R 1-41-- I do not wish to waive the 15'setback requirement.
(Prope er Inf motion) (Adjacent Property Owner Information)
gnature Signature*
ZpY/MI 1V \Fatal/ Awn! A4✓N� 1:10 Wow 0
Print or Type Name Pri bor Type Name
S P al Sf�w/►1It G 1-Ar014/Cz S y.� S411/M 141.- re-/0/VG--
Mailing Address Mailing Address
rb7f N C, ..27g'oeS/ Di y-. ',N t 7'>.P
City/State/Zip ity/Sta e/Zi
IVts -yFs -s�7r has)-/ I ?— Icy/
Telephone Number/email address Telephone Number/email address
%"Ly / )r� n /7 77k 1 y/i-4 d 6
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to JNYA lye 1r01Z9/9/✓
(Name of Property Owner)
property located at S Y ,s h/�1 G L t AAO/' / C
Address Lot, Block, FI!oad etc.)
on /)4 Vf y C1 v — , in fl61f1 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
0
J I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individoeproposbig dewelvyr ietg ttiesOltl lr'ttesOripflon below or attache site drawing)
14.
le° 01°
r
196LAG
r-,
`� " • - ION � �i✓
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.
1C --7I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjac t e Owner Information)
Signature S+2nat e*
p"U cAt2/L
Print or Type Name Print or Type Name
�Y S� eveiv/ Sail lot'' ' L/4,a jf/L
M in A dress M n Address �y
/VC R 78'eT t7i/17,9r/vC- 4w 7 Pi
City/State/Zip City/State/Zip
s)- y rs --s., 7�
Telephone Number/email address Telep ne Number/email address
Dat '94Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*
•
tiC Divisions of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: So\nln r' c,,r
Date: CI 19 f 20 ZOS
General Permit At:
Describe below the HABITAT disturbances for the application. All values should match he name,and units of measurement
found in your Habitat erode sheet.
TOTAL Sq. Ft I FINAL Sq, Ft. j TOTAL Feet FINAL Feet .
(Applied for. (Anticipatedfirtal ! (Applied for. (Anticipated final
DISTURB TYPE ! Disturbance total disturbance Disturbance ! disturbance.
Habitat Name Choose One ncludes any Excludes try total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or ems restoration or temp impact
temp impacts) impact am cunt) temp impacts) amount)
OW �
; Dredge 0 Fill❑ Both 0 Other ; ID4 2' ! ys6,4Z
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