20071357 Ver 2_Modifications_20090529

Gahagan & Bryant Associates, Inc.
295-A N. Green Meadows Drive
Wilmington, NC 28405
[phone]
[phone] FAX
[e-mail]
May 29, 2009
Ms. Heather Coats
NC Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Mill Creek Restoration Project at Washington Acres
Minor Modification to DENR Permit #175-07
Dear Mr. Coates:
Please allow this letter to serve as written request for a minor modification for the referenced project.
As you aware, the Entrance Channel was originally included in the initial permit application (2007). However,
at the time of submittal the existing depths did not warrant any maintenance efforts, and it was removed from
the project. Since that time, the Entrance Channel has shoaled to depths ranging from 0.0 ft MLW to 3.0 ft
MLW. Therefore, we would like to include the Entrance Channel maintenance efforts as a minor modification
to the existing permit.
A $100.00 check has been enclosed, as well as the modified MP-1, MP-2 forms, project narrative, and
drawings. Please contact us as soon as possible if there are any questions or concerns.
Thanks you in advance for your assistance with this request.
Sincerely,
GAHAGAN & BRYANT ASSOCIATES, INC
C. Paul Pascarosa
Environmental Specialist
Enclosures
cc: Mr. Stuart Mossman, Washington Acres HOA
NY. David Timpy, USACE
wls. Joanne Steenhuis, DWQ
BALTIMORE, MD HOUSTON, TX Los ANGELES, CA SAN FRANCISCO, CA TAMPA, FL WILMINGTON, DE
[phone] [phone] [phone] [phone] [phone] [phone]
Gahagan & Bryant Associates, Inc.
295-A N. Green Meadows Drive
Wilmington, NC 28405
[phone]
[phone] FAX
[e-mail]
MA'
t
ENGINEERS * SURVEYORS
May 29, 2009
Ms. Heather Coats
NC Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Mill Creek Restoration Project at Washington Acres
Minor Modification to DENR Permit #175-07
Dear Mr. Coates:
Please allow this letter to serve as written request for a minor modification for the referenced project.
As you aware, the Entrance Channel was originally included in the initial permit application (2007). However,
at the time of submittal the existing depths did not warrant any maintenance efforts, and it was removed from
the project. Since that time, the Entrance Channel has shoaled to depths ranging from 0.0 ft MLW to 3.0 ft
MLW. Therefore, we would like to include the Entrance Channel maintenance efforts as a minor modification
to the existing permit.
A $100.00 check has been enclosed, as well as the modified MP-1, MP-2 forms, project narrative, and
drawings. Please contact us as soon as possible if there are any questions or concerns.
Thanks you in advance for your assistance with this request.
Sincerely,
GAHAGAN & BRYANT ASSOCIATES, INC.
C. Paul Pascarosa `
Environmental Specialist
Enclosures
cc: Mr. Stuart Mossman, Washington Acres HOA
W. David Timpy, USACE
Xs. Joanne Steenhuis, DWQ
BALTIMORE, MD HOUSTON, TX LOS ANGELES, CA SAN FRANCISCO, CA TAMPA, FL WILMINGTON, DE
[phone] [phone] [phone] [phone] [phone] [phone]
Gahagan & Bryant Associates, Inc.
295-A N. Green Meadows Drive MA
Wilmington, NC 28405
[phone]
[phone] FAX
[e-mail] ENGINEERS * SURVEYORS
May 29, 2009
Ms. Heather Coats
NC Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Mill Creek Restoration Project at Washington Acres
Minor Modification to DENR Permit #175-07
Dear Mr. Coates:
Please allow this letter to serve as written request for a minor modification for the referenced project.
As you aware, the Entrance Channel was originally included in the initial permit application (2007). However,
at the time of submittal the existing depths did not warrant any maintenance efforts, and it was removed from
the project. Since that time, the Entrance Channel has shoaled to depths ranging from 0.0 ft MLW to 3.0 ft
MLW. Therefore, we would like to include the Entrance Channel maintenance efforts as a minor modification
to the existing permit.
A $100.00 check has been enclosed, as well as the modified MP-1, MP-2 forms, project narrative, and
drawings. Please contact us as soon as possible if there are any questions or concerns.
Thanks you in advance for your assistance with this request.
Sincerely,
GAHAGAN & BRYANT ASSOCIATES, INC.
C. Paul Pascarosa
Environmental Specialist
Enclosures
cc: Mr. Stuart Mossman, Washington Acres HOA
M. David Timpy, USACE
TA4s. Joanne Steenhuis, DWQ
BALTIMORE, MD HOUSTON, TX LOS ANGELES, CA SAN FRANCISCO, CA TAMPA, FL WILMINGTON, DE
[phone] [phone] [phone] [phone] [phone] [phone]
Minor Modification to
NCDENR Permit # 175-07
Table of Contents
I. Permit Application
1. MP-1
2. MP-2
3. Authorized Agent Form
II. Project Narrative
1. Narrative
2. Upland Disposal Property Owner Authorization Letter
3. General Permit for Entrance Channel (8/2/06)
III. Drawings
1. Sheet 1- Site Map
2. Sheet 2 - Entrance Channel, Plan View
3. Sheet 3 - Entrance Channel, Cross Sections
4. Sheet 4 - Upland Disposal Site, Plan view
Permit Application
DCM MP-1
APPLICATION for
Major Development Permit
(last revised 12/27/06)

North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
Mill Creek Waterway Restoration, Inc. Project Name (if applicable)
Mill Creek Entrance Channel (and Battery Lane Creek)
Applicant 1: First Name
Stuart MI Last Name
Mossman
Applicant 2: First Name MI Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
411 Hughes Road PO Box City
Hampstead State
NC
ZIP
28443 Country
USA Phone No.
910 - 270 - 3133 ext. FAX No.
-
Street Address (if different from above) City State ZIP
Email
[e-mail]
2. Agent/Contractor Information
Business Name
Gahagan & Bryant Associates, Inc.
Agent/ Contractor 1: First Name MI Last Name
Chris L Gibson
Agent/ Contractor 2: First Name MI Last Name
Carmen P Pascarosa
Mailing Address PO Box City State
295-A North Green Meadows Drive Wilmington INC
ZIP Phone No. 1 Phone No. 2
28405 910 - 313 - 3338 ext. 910 - 279 - 4777 ext.
FAX No. Contractor #
910 213 6822
Street Address (if different from above) City State ZIP
Email
[e-mail]-, [e-mail]
<Form continues on back>
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Form DCM MP-1 (Page 2 of 2)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple) Street Address State Rd. #
Fender Hughes Road/Washing Acres Rd
Subdivision Name City State Zip
Washington Acres Hampstead NC 28443-
Phone No. Lot No. (s) (if many, attach additional page with list)
910 - 270 - 3133 ext.
a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project
Cape Fear Mill Creek
c. Is the water body identified in (b) above, natural or manmade? d. Name the closest major water body to the proposed project site.
®Natural ?Manmade ?Unknown AIWW
e. Is proposed work within city limits or planning jurisdiction? f. If applicable, list the planning jurisdiction or city limit the proposed
?Yes ®No work falls within.
4. Site Description
a. Total length of shoreline on the tract (ft.) b. Size of entire tract (sq.ft.)
NA
c. Size of individual lot(s) d. Approximate elevation of tract above NHW (normal high water) or
NA, NWL (normal water level)
(If many lot sizes, please attach additional page with a list) -3' MLW ?NHW or ?NWL
e. Vegetation on tract
None
f. Man-made features and uses now on tract
The Entrance Channel is a natural waterway connecting Mill Creek to the AIWW, however, maintenance is required in order
create a navigable waterway for the residents of the Mill Creek Subdivision
g. Identify and describe the existing land uses adiacent to the proposed project site.
Residential
h. How does local government zone the tract? i. Is the proposed project consistent with the applicable zoning?
NA (Attach zoning compliance certificate, if applicable)
?Yes ?No ®NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ?Yes NNo
k. Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. ?Yes ®No ?NA
If yes, by whom?
1. Is the proposed project located in a National Registered Historic District or does it involve a ?Yes ®No ?NA
National Register listed or eligible property?
<Form continues on next page>
25 -808- 808 1-888--4PC0A T vvuvrtb.?€ccez??aair???r? ?err?er=?, ??t
Form DCM MP-1 (Page 3 of 3)
APPLICATION for
Major Development Permit
FI re there wetl ands on the site? ®Yes ?No
re there coastal wetlands on the site? ®Yes ?No
f yes to either (i) or (ii) above, has a delineation been conducted? ®Yes ?No
(Attach documentation, if available)
n. Describe existing wastewater treatment facilities.
Private Septic Systems
o. Describe existing drinking water supply source.
Private Wells
p. Describe existing storm water management or treatment systems.
NA
5. Activities and impacts
a. Will the project be for commercial, public, or private use? ?Commercial ?Public/Government
®Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
Provide water access to existing boating docks and riparian properties
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
Mechanical dredging by means of a bucket dredge (excavator) and barge. The excavated material will be disposed of in a
designated upland area located within the Washington Acres subdivision. (see project description for more details).
d. List all development activities you propose.
Mechanical Dredging of approximately 1,900 cy of sediment from Entrance Channel of Mill Creek.
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What is the approximate total disturbed land area resulting from the proposed project? 21900 ®Sq.Ft or ?Acres
g. Will the proposed project encroach on any public easement, public accessway or other area ?Yes ®No ?NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Based on the operating techniques of mechanical bucket dredging, little to no discharge will occur.
i. Will wastewater or stormwater be discharged into a wetland? ?Yes ®No ?NA
If yes, will this discharged water be of the same salinity as the receiving water? ?Yes ?No ®NA
j. Is there any mitigation proposed? ?Yes ?No ®NA
If yes, attach a mitigation proposal.
<Form continues on back>
252-F, -.2C0Z 1 888-4 T vrww.n;--CG St aImana9emC- fr.r,C
Form DCM MP-1 (Page 4 of 4)
APPLICATION for
Major Development Permit
6. Additional Information
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) -(0 are always applicable to any major development application. Please consult the application
instruction booklet on how to properly prepare the required items below.
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross-sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as.proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
Name NA - Adjacent Property owners are permitees on permit for which this application is Phone No.
a modification
Address
Name Phone No.
Address
Name Phone No.
Address
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
NCDENR 175-07; Community Creek Front POA, Waters Edge NCDENR DWQ Project #07 1357 V2; Horne Creek Extension,
at DeerField, Decemebr 12, 2007 Modification to Mill Creek Dredging Project, Oct. 6, 2008
Consent Agreement DACW21-9-07-6136; Mill Creek Waterway
Restoration, Inc.; October 17, 2007
h. Signed consultant or agent authorization form, if applicable.
i. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
7. Certification and Permission to Enter on Land
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit-
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date 5/20/09
Print Name Carmen Paul Pas
Signature
Please indicate application attachments pertaining to your proposed project.
®DCM MP-2 Excavation and Fill Information ?DCM MP-5 Bridges and Culverts
?DCM MP-3 Upland Development
?DCM MP-4 Structures Information
Z -808-280a ,. I- 8 & - 4 P C 0 A a°6 .. wvvw.nc:coa !? tairna a9eme,ntf ei

Form DCM MP-2
EXCAVATION and FILL
(Except for bridges and culverts)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
Describe below the purpose of proposed excavation and/or fill activities. All values should be given in feet.
t ` Access

Channel
?

R
k
Other
l

(NLW or Canal Boat Basin Boat Ramp Rock Groin
oc
(exc
uding

NWL Breakwater shoreline
stabilization
Length 730 ft
Width 30 ft
Avg. Existing

Depth -3.0 ft MLW NA NA
Final Project

Depth -5.0 ft MLW NA NA
1. EXCAVATION, ?This section not applicable
a. Amount of material to be excavated from below NHW or NWL in b. Type of material to be excavated.
cubic yards. Silty sand, Mud
Entrance Channel - 1,900 cy
c. (i) Does the area to be excavated include coastal wetlands/marsh d. High-ground excavation in cubic yards.
(CW), submerged aquatic vegetation (SAV), shell bottom (SIB), 0
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV ?SB
?WL ®None
(ii) Describe the purpose of the excavation in these areas:
Provide water access to residential docks
2. DISPOSAL OF EXCAVATED MATERIAL ?This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
Property of Mr. Jeremiah Reeves. Parcels 3291-06-7487, .65 acres
3291-06-7348,3291-06-6289
c. (i) Do you claim title to disposal area? d. (i) Will a disposal area be available for future maintenance?
?Yes ®No ?NA ®Yes ?No ?NA
(ii) If no, attach a letter granting permission from the owner. (ii) If yes, where?
Disposal Area #205
e. (i) Does the disposal area include any coastal wetlands/marsh f. (i) Does the disposal include any area in the water?
(CW), submerged aquatic vegetation (SAV), shell bottom (SIB),
?Yes ®No ?NA
or other wetlands (WL)? If any boxes are checked, provide the
number of square feet affected. (ii) If yes, how much water area is affected?
?CW ?SAV ?SB
?WL ®None
(ii) Describe the purpose of disposal in these areas:
N m r ctf 3)
5/22/09
Date
Entrance Channel and Battery Lane Creek - Additional
maintenance efforts to the Mill Creek Dredging Project
(Permit# 175-07)
Project Name
Mill Creek Waterway Restoration, Inc.
Applicant Name'
Applicant Signature
reviseJ: '122261
For DCM SIP-2 (Excavation and Fill, Page 2 of 2)
3. SHORELINE STABILIZATION 0This section not applicable
(if development is a wood groin; use MP-4 Structures)
a. Type of shoreline stabilization:
?Bulkhead ?Riprap ?Breakwater/Sill ?Other:
c. Average distance waterward of NHW or NWL:
e. Type of stabilization material:
g. Number of square feet of fill to be placed below water level.
Bulkhead backfill Riprap
Breakwater/Sill Other
i. Source of fill material.
b. Length:
Width:
d. Maximum distance waterward of NHW or NWL:
f. (i) Has there been shoreline erosion during preceding 12
months?
?Yes ?No ?NA
(ii) If yes, state amount of erosion and source of erosion amount
information.
h. Type of fill material.
4. OTHER FILL ACTIVITIES 0This section not applicable
(Excluding Shoreline Stabilization)_ .
a. (i) Will fill material be brouqht to the site? ?Yes ?No ?NA b. (i) Will fill material be placed in coastal wetlands/marsh (CW),
If yes,
(ii) Amount of material to be placed in the water
(iii) Dimensions of fill area
(iv) Purpose of fill
submerged aquatic vegetation (SAV), shell bottom (SB), or
other wetlands (W L)? If any boxes are checked, provide the
number of square feet affected.
?CW ?SAV ?SB
?WL ?None
(ii) Describe the purpose of the fill in these areas:
f 5 GENERAL
a. How will excavated or fill material be kept on site and erosion b. What type of construction equipment will be used (e.g., dragline,
controlled? backhoe, or hydraulic dredge)?
Silt fencing will be established prior to the disposal efforts. Material Excavator/backhoe, loading barge, and dump truck
will be transported from the barge (via excavator) to a hauling
truck, and dumped within the silt fencing on the property of Mr.
Reeves.
c. (i) Will navigational aids be required as a result of the project?
?Yes ENo ?NA
(ii) If yes, explain what type and how they will be implemented.
d. (i) Will wetlands be crossed in transporting equipment to project
site? ?Yes NNo ?NA
(ii) If yes, explain steps that will be taken to avoid or minimize
environmental impacts.
252-8038-2808 :: 1-888-462Cf. AST :. wwue.nccoastallmanagement.net revised: 1212W0
Fob D P-2 (Excavation are bill, Page 3 of 3)
5/22/09
Date
Entrance Channel and Battery Lane Creek -'Additional
maintenance efforts to the Mill Creek Dredging' Project
(Permit# 175-07)
Project Name
Mill Creek Waterway Restoration, Inc.
Applicant Name
17
Applicant at
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Q??
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date May 20, 2009
Mill Creek Waterway Restoration, Inc.
Applicant Name
Mailing Address
411 Hughes Road
Hampstead, NC 28443
I certify that I have authorized (agent)
Mr. C. Paul Pascarosa of GBA, Inc.
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
excavate material from the Entrance Channel to Mill Creek & the Battery Lane Canal
ftt (leeatieflj as a modification to Permit # 175-07
'% /11,111 --,- 2 o A 0 '??
This certification is va ' (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 1 10% Post Consumer Paper
Mill Creek Dredging Project
Minor Modification to NCDCM Permit #175-07
"Mill Creek Entrance Channel"
Purpose:
The objective of this permit modification is to add the "Mill Creek Entrance Channel" to
the existing Mill Creek Maintenance Dredging Project. The Entrance Channel has
shoaled to depths that limit navigation to smaller boats, and it does not meet the current
depth of the recently dredged Mill Creek.
The Entrance Channel was originally included in the overall scope of the Mill Creek
Dredging project. However, at the time the project began (summer 2007), the existing
depths did not warrant maintenance efforts, and it was not included in the permit
application. Based on our before dredge survey (November 11, 2008) and our after
dredge survey (May 4, 2009) it became evident that the Entrance Channel was in need of
maintenance. Portions of the Entrance Channel are quite shallow, and range from 0.0 ft
MLW to 3.0 ft MLW.
Existing Conditions:
The Entrance Channel is the connecting waterway to Mill Creek from the AIWW. It is
approximately 730 feet long and 30 feet wide. Existing depths range from 0.0 ft to -5.0
ft MLW. Although parts of the Entrance Channel are at -5.0 ft MLW, the western side of
the first 500 feet of the channel are ranging from 0.0 ft to -3.0 ft MLW (see drawings).
Proposed Activities and Construction Logistics:
This minor modification request proposes to excavate approximately 1,900 cubic yards of
material from the Entrance Channel. The proposed depth of the Entrance Channel is to a
depth of -5.0 ft MLW. The excavation method will consist of a mechanical dredge
(excavator and barge), operated by Maritech, LLC.
The dredge spoil will be transported to a hauling truck, and disposed of on an upland site,
located on three (3) vacant parcels across from 2210 Washington Acres Road. The size
of the disposal area is approximately .65 acre (28525.25sq. ft.). The disposal of 1,900
cubic yards will result in a .41 ft rise in elevation. In addition to the material from
Battery Lane Canal (Letter of Refinement 5/22/09), the total rise in elevation will be .73
ft. Therefore, properly installed silt fencing will effectively ensure all sediment and
erosion control measures are met. Additionally, the disposal area will be outside of the
30 ft set back. The current owner of the upland disposal site is Mr. Jerry Reeves, and his
letter of consent is enclosed.
Project Description Page 1 of 1
Environmental Concerns:
Based on approval of the original Mill Creek Dredging Project and coordination with
regulatory agencies, it appears the maintenance of the Entrance Channel will pose little, if
any, adverse affects on the surrounding environment. It is within the same general
footprint of the area covered by Permit 175-07. The "Bucket and Barge" dredging
technique is considered the least intrusive method of dredging. Therefore, we do no
expect any adverse affect on the surrounding environment.
Furthermore, the Entrance Channel was approved for dredging under a General Permit
issued on August 2, 2006 (Rover File# 5031515A). Additionally, all appropriate
measures will be taken to ensure the dredging operation is within the scope of all
applicable standards and regulations.
Project Description Page 2 of 2
May 11, 2009
Maritech, LLC c/o Adam Knierim
108 Circle Drive
Hampstead, NC 28443
Dear Mr. Knierim,
1 grant permission solely to Maritech Dredging for use of my properties located at Lots
411, 412, and 413 (Parcel ID's 3291-06-7487, 3291-06-7348, and 3291-06-6289,
respectively) in Long Point Estates on Washington Acres Rd in Hampstead to dispose of
dredge spoil material. Disposal will be limited to the upland portion of the property
outside of the 30ft buffer zone. Sedimentation and erosion control measures (silt fencing)
will be in place before placement of material on the propery.
Sincerely,
Jerry Rkevds/ _
2210 'vashington Acres Rd
Hampstead, NC 28443
May 29 09 09:18a Home 919 270 3133 P.1
%?F?MA 1 F?UREDGE & FILL -
• 6ENERAL PERMIT Previous Permit=
ew DModification OComplete Reissue LJPartial Reissu e Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC J.
f .RaTes attached.
Applicant Name./.' 1L_1 1)GG:K .' i Vie t _ ?it=?c , '•'"? rl,,, ? c:'r Protect Location: County j -?•ii? ! - --

a7?iih ?_?ylf? _
Address i1V
Street Address/ State Road/ Lot #(s)- _, rT;
- ----- ---
State `e ZIP_.)OV
Cih`_el?Jlip jQ?fr)4
_ -- - ----.??. _
Phone # Fax # Subdivision >
Authorized Agent _,,4, /4?7 t1' V, i ?GS„?1 Ciry- ' -_ - ZIP
L Cw E,?,EW {jhTA ?tE's G P"rs Phone #
River Basin
(
)
Affected ----
----- ---
D OEA ? HHF ? IH L; UBA ? N/A
AEC(s):
Adj. Wtr. Body_/,! t _ {nat-'/man_ /unkn)
? PWS: f:FC:

ORW: yes //no./ PNA yes / no Crit. Hach. yes / no _
Closest Maj. Wtr, Body ?f'..r ' ? -----
Type of Project/ Activity jrJr v`v?y'i`Gr==:c"tttl-it L
(Scale: )
Pier(dock)length _
Pladorm(s)___
Finger pier(s) --
Groin length -- -
number ,- ---- ---
Bulkhead/ Riprap length _
avg distance offshore
max distance offshoreBasin; channel

jam[
cubic Yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing. -
Other-

/0 f

Shoreline Length
SAV: not sure yes no ;
Sandbags: notsure yes no.:
Moratorium: n/a yes'
Photos: yes
Waiver Attached: yes
A building permit may be required by: ?; , Tye / L] See note on back regarding River Basin rules.
Notes/ Special Conditions..,- r
ent or A
Ag pph c.?t[ RrinCj'd Name
l '?! •?^/mar .? ?- ?_.•_-
Signature `*,Please read compliance statement on back of permit
Application Fet:(s) Check #
. I
r T rL
Pe,t% Officer's Signature i

Issuing DSte cpiratio Date

Local Planning Jurisdiction Rover File Name
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