19980358 Ver 1_COMPLETE FILE_19980420

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
June 5, 1998
Brunswick County
WQC 401 Project # 980358
APPROVAL of 401 Water Quality Certification
Mr. Thomas K. Moore
224 Hillside Avenue
Charlotte, NC 28209
Dear Mr. Moore:
You have our approval, in accordance with the attached conditions, to place fill material in 0.032 acres of wetlands
or waters for the purpose of residential lot and development at Lot 18 on Shoreline Drive, Twin Lakes Development, as
you described in your application dated April 17, 1998. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3106. This Certification allows to use Nationwide Permit
Number 18 when the Corps of Engineers issues it. In addition, you should get any other federal, state or local permits
before you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater,
Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when the accompanying 404 or
CAMA permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application for a new certification. If the property is
sold, the new owner must be given a copy of the Certification and approval letter and is thereby responsible for complying
with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory mitigation
may be required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions
listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh,
N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please telephone John Domey at 919-733-1786.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
Wilmington DWQ Regional Office
Mr. John Domey
Central Files
lo ard,
Pn

980358.1tr
s
Division of Water Quality • Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone]
FAX [phone]
An Equal Opportunity Affirmative Action Employer 9 50% recycled/10% post consumer paper
1
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224 Hillside Avenue
Charlotte, NC 28209
April 17, 1998
I. Mr. Alan Davis
U. S. Corps of Engineers
P. O. Box 1890
Wilmington, NC 28402-1890
Dear Mr. Davis:
Further to our earlier conversations and your site visit to the property with Mr. Eddie Walters, I am owner
of Lot #18 on Shoreline Drive, Twin Lakes Development, Sunset Beach, NC, and I wish to apply for a
permit to cover approximately 1500 square feet of wetlands.
Lot #18 is 80.3' wide, running 301.31' on the eastern boundry and 268.81' on the western boundry. We
have a tidal creek on the western property line being fed by a culvert running under Shoreline Drive
allowing runoff from two lakes on Oyster Bay Golf Course. This creek works it's way onto the lot, re-
stricting the buildable area by some 25-30%. In that there is no sewer system serving the property, our set-
back regulations require 60' rather than 50' if we had a sewer system.
As per the attached sketch and pictures, I propose to build a bulkhead parallel to the western property line,
never restricting the tidal creels to less than 15'. This filled bulkhead is needed because according to the
site evaluation report attached, a permit was issued for a 4 bedroom septic system on the left (eastern) side
of the lot with a 1000-gal. tank and three lines 45' in length by 36" wide. This evaluation also calls for the
driveway to be on the right (western) side of the lot (see attached plat). To get the driveway along the west
side of the house and have adequate room to turn out of the garage, the extra width is necessary. Building
the bulkhead and back filling will accomplish the following:
1. The buildable area of the lot will increase to enable us to build a house comparable to
others in the neighborhood;
2. The creek bank will be stabilized to insure no further erosion of the creek bards;
3. Positioning of the house and driveway closer to the creels bank will preserve several
live oak trees which otherwise will have to be removed.
Thank you for your consideration of this matter; I look forward to hearing from you.
Sincerely,
Thomas K. Moore, Jr.
encls

t xw
DEM ID: C CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): _
?? U lJ
PRE-CONSTRUCTION NOTIFICATION A II?'?? L
FOR NATIONWIDE PERMITS THAT REQUIRE:
WE[LRNDS GROUP n?
1) NOTIFICATION TO THE CORPS OF ENGINEERS'
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO TIE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME:
--I-, om -?S 1-:?, , 4 Kn,+hIElz t-3 1C.. • moo P_ T_
2. MAILING ADDRESS : a a 4 ? I `S ?C A yz..J U F-
CITY : C H A P-LO,1TE STATE :
SUBDIVISION NAME :
N.c, ZIP CODE: 080-109
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): lb+ !$ 4 WCSTE?fJ 3E:CTi0rh C-4
`w 1, +? ??5 S D- ?? W a r U? s w i ?ou??
3. TELEPHONE NUMBER (HOME) (WORK) S?O'Y
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: NZ
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Q2u NSw. ck- NEAREST TOWN OR CITY:
a
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):
LID7 -a- IS WEs?tzw sac-rio J E i Fw IAN h l\\'(-E.S
27aj uc- CA cr os_s o,v, 2 k) D P-14 I' -p-, L'j
o, `-e Co,-- F Cou 9,S r--- -
6. IMPACTED OR NEAREST STREAM/RIVER : J ti- E.P-COA S-Ff' lL W A-rr-- Z W A L:
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT,.TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE MATERS (ORW),
WATER SUPPLY ( WS - I OR WS-II)? YES A QC] NO [ ] IF YES, 1EXPLAIN :
1 T?'2CbP,sT-A WAtao--WAY A?I3b l ', At? WA" zR./PZeS"
ITVRTEC P-Ukj-DI"IT PIZOYII GOLF COUQSE AT
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES XJ NO [ ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP)
DESIGNATION?
L-?,,2soNjAL-
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO X IF YES, PROVIDE ACTION I.D. NUMBER
OF PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY
OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO K IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: ?Q pe0?- Vz Acec:
:o
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT
SITE: 1/4 Ac-
2.C-10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:

FILLING: t") D r?- CO, ?t.
FLOODING:
DRAINAGE:
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED : I1 L4 OR SQ 4.
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSEZ PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE : N /p,. FT AFTER : N /4 FT
WIDTH BEFORE (based on normal high water contours): h'j r, FT
WIDTH AFTER: / NA FT
AVERAGE DEPTH BEFORE: ` A FT AFTER: N /41v FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT
APPLY)
OPEN CHANNEL RELOCATION: W /A PLACEMENT OF PIPE IN CHANNEL: QJA_
CHANNEL EXCAVATION: MAA - CONSTRUCTION OF A DAM/FLOODING: N/A,
OTHER : N /P,
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? Q A
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO/?BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) ?2b?aSA? T? 0005--000+- /? Qut?lc NE14? g8,C)" puoc
3a'o" 5EE Awch??) ??D ?ACk Fi??
( ? y 03 5 C?, ??ET, CO 'R `DEPTH 0P
.' 40
13. PURPOSE OF PROPOSED WORK : O P-O V t s::)G ADC- of TE L?U i ?G
SPoa FDe- A q-3`0"X gc ?Ot' Foo'r Pk43i o,v?t-- 43 4EC-Pi "3 G csJi ?? *he
Rtyc? ANA Peb6lE OF- NELC?,Nf?[n(2,RooL) (O S?2 i?? C?iS??oJG C2EEIC
jAu k SAVi 1J & -[ZQ n Li vF- bAY-5 .
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE
WETLAND IMPACTS): //
iTN No SLweg AKp THE. { 9CG:5(TY F-02. A SC:9T?C-/M I gFLIL? S?sT?m?
??T?flc? ?P?m 5Ti2t-?.T C'?F?'?n SD?TObb? Si?C? ??t'icS?,?ST?.M
Nn,?TIIc- oo LPFT SQe Du yr-- T o O -P-ezKSb'ERSeme)T.Je;vE Mus-r
]BE Ct,) L:?c w-r A"p 5 DACz M USr RE. AVlDr--,D FDP- ruR %E: PLA-F
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE
Spoke, WiTFt Ct,?ot:-LS MAeTtvzo AND SNE QEpoQ."rs TNRT TtAE l?G0 W?v?
CONTACTED: TAB CA2-- OF THE Mw1rEYZ, wf+e*j eEQUE?
,,7- ?eiE ACH
RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION
OFFICER (SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF
HISTORIC PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE
PROPOSED PROJECT. DATE CONTACTED: L"-lcz - 19
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE
USE OF PUBLIC (STATE) LAND?
YES [] NO X (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN
ENVIRONMENTAL DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH
CAROLINA ENVIRONMENTAL POLICY ACT?
YES (I NO [
0
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [) NO []
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM
THE STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRIS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18,
21, 26, 29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE
PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS
50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL
DATA - COZPS 01:' C??fGlu SUrzve? aQ per, -T,
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? R?cSE.D?N > ? R
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
S' E P TA c. -v ke- - S ?E ?` A T
O
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR
TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE
PROPOSED ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL
MANAGEMENT PROGRAM.
?.
0 ER'S/A ENT'S SIGNATURE
4-ao-ag
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
G\?? 9? uAl4. k:a P019M pots .
O???E 2„ ?w ELe1A11br?' =10.1-i
6
,??, n 80 SeTafCv.
E_ 7E OP BANK
h1°? -c4 (= 5 32°42'22° E, 116.22'
• \ ??p,r? ts, 2 = 554°3?i'06" E, 36.37';_.
GAre. 3 = 5 30°32'24" E, 143.22
40? N
' 4
Etc 404 LINES
pq ?? /? \ A = N 64°10'13"
oil F
. 404 molE 1 C
r.PIFICATE FOR U.S. ARMY CORPS OF
r gGINEER.S - THIS C E=IES THAT THIS COPY \
.OF THIS PLAT ACCURATELY DEPICTS THE BOUND \ C.
zpE: THE JURISDICTION OF' SECTION 404 OF THE '(, _
YMTER ACT UNDER TIM PRES'ENT' LAW AND \ \ t?
.,MG=ICNS AS DETERMI?IEi D BY' TIE UNDERSIC-??IE?D
. ' LESS THERE . IS A CHANCE IN TF
"sue THIS DATE. UN
`SLAW 'OR OUR PUBLISHED REGULATIONS, THIS
r,DETER? ICN OF SECTION 404 JURISDICTION MAY BE
RED UPON R A PERIOD NOT TO EXCEED THREE
Y _ 1 S' f Cr 9S' \ \ _ _ -
RPS CF GIlVEERS - DATE \ -
88.00' .. ;e
88°4=-'14" N -
. ? ?' - • ••?? "" " 6 V JETQgCK
o?'y?' EDGE 0.E= 5ANK
N?°° a I 5 32°42'2" E 116.22' M-
r_ 534°3?i'O6" E, 56.37
\ ',? Sato G ?? . 3 = 5 30°32'24 E, 143.22;
4 N \ s
-, • rr cp ? Y ?,F?? 404 LINES
ti
4 \ ?? A = N 64°10'13 E,
5 = S 05°0-1'50" E,
4-04 LiNf I c
LO T 117
7\
I_CEII'IFICATE FOR U.S. ARMS.' .CORPS OF
ENGINEERS -'THIS CERTIFIES THAT THIS COPY \
.OF THIS PLAT ACCURATELY DEPICTS THE BOUND \ f.
tF THE JURISDICTION OF SECTION 404 OF WAN'
TQATER ACT UNDER TEE PRESENT LAW AND \ \ t?
..REGULATIONS AS DETZRT= BY-TIE UNDERSIGM
s-CN THIS DATE..' UNLESS THERE IS A CHANCE IN TIC \ ` =rte
`_LAW 'OR OUR PUBLISHED REGULATIONS, THIS
=METTR41MAT $1 OF SECTION 404 JURISDICTION MAY BE
RELIED UPON R A PERIOD NOT TO EXCEED TI
RPS OF GINEERS DATE _ \ - =-
rr 88.00'
Ni 0604-414"
1^(
,. 5URVEY FOR
t THOMAS K. MOORS JR.
NOTES: OF
1. PROPERTY 15 IN A LOT # 18
FLOOD HAZARD AREA ..b WE57ERN SECTION E
EXI5TIN6 IRON N CSR
. ? ::? F , , ui ? L ,.°?•? 0, TWIN LAKES DEVELOPMENT
NG T REVISION AND EXTENSION
I JAN K. DALE. CERTIFY THAT THIS PLAT WAS DRAWN + C
BY ME FROM AN ACTU& SURVEY MADE UNDER MY S JPERY ION MAP 5K. 6, PAGE 20
THAT THIS PLAT WAS PREPARED IN ACCORDANCE WET}
G.S. 47-30 AS AMENDED. THE ERROR OF CLOSURE . ' L-12-0 SCALE TOWNSHIP GOUNTf STATE
AS COMPUTED BY THE D.M.D. METHOD; REFERENCE DEE S Jr,
do/OR PIATS• Ih -f,K ?? pc ?/ !???r r E
SHALLOTTE BRUNSWICK N.G.
+,. y 'Z'• Vic` ?;,.?'' '?
WETNESS MY ORIGINAL SIGNAT)11% REGISTRATION NUMBER JAN K. DALE N.O. REG• NO. L-
AND SEAL THIS V) DAY OF 11 i - • 19 f
bail GO°A5 ROAD - 5HALLOTTE, N.C. - .(qlq)
JAN K. DALE FIELD BOOK DRAYVN BY
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5KR I G W I4N fL / TW I N SAKES . / ___18/
CURRENT PAOFERTY O'r,74E3i St1BDN!S?ON LOT SLK SEC
SUNSET BEACH HWY 179 ACROSS MAKE
PROPERTY LOCATED,.TOWN/CITY/ARF_A/ DIRECTIONS To PROPERTY:
-A}#8•'-AY?6F?-SAY ?£-i"??_..
SITE EVALUATION REPORT ?- Did ram
FACTORS Al A2 A3 C Lt/
t) Stop&llan¢scape•poaon PS u S PS U fJ
2) A, $qit T*Xrjre 0 111 tV I if In IV
B. Sots StrucMe PS U S FS U IAt? ?f
31 row Drainage (Wea*ess) v PS U S PS U h 1
4) So,T Depth PS U 3 PS U
i) Resb'ic;ivel-lafzOn PS U S PS U Yl
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A L? d
A Hort;+k? I , '? +?, ? ?'L ii ? +1
?t+ Fiot!tan ( ?`C Iii vC C`C` • •
C ? non:an NOTTS: /VIP -1--rC? )' «l l-e•:
Ov+r aR site Olassfto ion: Suitable Prcrtsionaly auaat? o Unwita?Ia
Se.e dlogram a" (Or iocason of ; borings and orea 1 ation. /111 @ ?1 4 ? 4
Evahratedby Tom/ d eL (?f C ? r TAte: DsP /u
R+-Wafualed by: Oate; Rettassi?caSoR S -- F P5 U
41
NOT7E$:. 74
_ _ Drainage Flt _ A1temetive SYstern G Otter SEE REVERSE SIDE OR ATTACHED
,?,fffn m*m!In( P+rmlV _ Grt(flcata of Complatiorv0paratloh pwmlt EAVIng System 9015411' P'*-IVf'Re N0. r9 zN.? J 4iin?
/ G.S. CHAPTEA 130A AATTCLE Tt. G.S. i90A•333 et Sec. .Z
Ptrm!ttadfor:HMH Bus Mulj•Frunity Trerxh Dxtom Ar r Trench tx+ROm no deeper mAn: l
tJO.ltntta :No.BoOrocros SizAotTBn ?. ' ?/f?• ?/ sC 4?
No. LXre! leng'1t ea, -? f-...,.i?-•' ^ Trench wldOt (/ ?/ G/rJ e.
Watet SwOr.. Prtyato Pub!t jli?_ f P? r?
NOTE: ANY C14ANGES IN THE NATURE AND VOLUhtc OF SEWAGE OR CHANGE IN
LOCATION OF STRVCTUA£ WILL VOID PERMIT'. ' ?N?•?l/'
IMPROVEMENT PEA?AT VOtD/MOtTTHS FROM 0 TE OF SSUANCE. t3 !? f / ...
66- z
IMPROVEMENT PERMIT DATE: - { -- 0
CondNOn6:
1, 10
ey
7
Permit Na a n!e s Sid by Autrre tasait
?c
p L? < IK i 6T»cxT
?C N `Z• `I t ?'f?j ?? 1. Tt?1s(Rtrjll not baslrrtd ent by authority of Fltalth Dtpartrrynt. r
Mslalkd Uy `?? Crw-aw at & 9on/oFwwbon Permit App•oved by.
NOM- See Import2nt informacon on reverse side. (Permit Not Valid Un ss Slsned.bv Avlhod,?P6 AoPM.Sanitarianl Datat -- J.-..^--1"?