HomeMy WebLinkAbout20140028 Ver 1_CAMA Permit Application_20140102Pat McCrory
Governor
January 6, 2014
MEMORANDUM:
A Ah
2 C 0 0 2 8
NCDEE R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Braxton C. Davis
Director
TO: Karen Higgins
401 Oversight
DEMLR - Surface Water Protection
John E. Skvarla, III
Secretary
FROM: Doug Huggett, NC DENR -DCM Major Permits Co
400 Commerce Ave., Morehead City, NC 28557 (Courier 11- 12 -09)
SUBJECT: CAMA Major Permit Application Review
Applicant: Hap Alexander
Project Location: Harbor Sound / Waters Bay access channel,
adjacent to the AIWW in Surf City, Pender County
Proposed Project: installation of six (6) channel markers, and a "danger marker"
Please indicate below your agency's position or viewpoint on the proposed project and return this
form to Douai Hucrarett at the address above by January 30, 2014. If you have any questions
regarding the proposed project, contact Jason Dail at (910) 796 -7215, when appropriate, in -depth
comments with supporting data is requested.
REPLY: This agency has no objection to the project as proposed.
SIGNED
This agency has no comment on the proposed project.
This agency approves of the project only if the recommended changes are
incorporated. See attached.
This agency objects to the project for reasons described in the attached comments.
DATE
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: 910 -796 -7215 \ FAX, 910 - 395 -3964 Internet: www.nccoastalmana-Qement.net
An Equal Opportunity 1 Affinnahve Action Employer
JQN g ?014
DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
APPLICANT'S NAME: Hap Alexander
2. LOCATION OF PROJECT SITE: Harbor Sound/Waters Bay access channel, adjacent to the AIWW,
in Surf City, Pender County.
Photo Index - 2006: 26 -6628, D -F, 10 2000: 26 -346, S -U, 15 1995: 26 -330, U -W, 17
State Plane Coordinates - X: 742726 Y: 76805 GPS File: N-12311 IA
Lat: 34 °26'00.972 "N Long: 77 °33'05.492 "W
3. INVESTIGATION TYPE: CAMA
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit — 12/31/13
Was Applicant Present — No
5. PROCESSING PROCEDURE: Application Received — Complete 12/20/13
Office - Wilmington
6. SITE DESCRIPTION:
(A) Local Land Use Plan — Town of Surf City
Land Classification from LUP — Conservation, Resource Protection
(B) AEC(s) Involved: PTA, EW
(C) Water Dependent: Yes
(D) Intended Use: Private/Public
(E) Wastewater Treatment: Existing — N/A
Planned — N/A
(F) Type of Structures: Existing — N/A
Planned — Six (6) channel markers (4 red and 2 green) and "danger
marker ".
(G) Estimated Annual Rate of Erosion: N/A
Source - N/A
7. HABITAT DESCRIPTION: [AREA]
T)RF.DC'TF.T) FTT.T.F.T) OTNRR
(A) Vegetated Wetlands (Coastal
Wetlands)
(B) Non - Vegetated Wetlands
Six (6) sq. ft.
(Open water)
(C) Other (High ground)
(D) Total Area Disturbed: Six (6) sq. ft.
(E) Primary Nursery Area: No
(F) Water Classification: SA Open: No
8. PROJECT SUMMARY: The applicant proposes to install six (6) channel markers, and a "danger marker"
adjacent to the dredged channel in the Harbor Sound/Waters Bay access channel.
Hap Alexander - Harbor Sound Navigation Aids
Page Two
9. PROJECT DESCRIPTION:
The project site is located adjacent to Sears Landing and Harbor Sound/Waters Bay, which is located at 716
Roland Avenue, in Surf City, Pender County. To get to the project site from the Wilmington office, head north on
US Hwy 17 toward Jacksonville. At the intersection of US Hwy 17 and NC Hwy 210, turn right onto NC Hwy
210 towards Surf City. The project site will be located on the left hand side of the road, just before the Surf City
swing bridge.
The areas west and south of the project site are a combination of residential and commercial properties and the
area to the north and east is comprised of Harbor Sound/Waters Bay and the AIWW, respectively. Combined, the
commercial and residential properties have approximately 600 linear feet of shoreline bordering the Harbor
Sound/Waters Bay canal. The adjacent upland areas average approximately 12' above mean high water (MHW ).
Lawn grasses and ornamental landscaping dominate the upland vegetation and small patches of Smooth Marsh
Cordgrass (Spartina Alternaflora) exist just north of the existing bulkhead. Currently, the entire shoreline
bordering the access channel is stabilized by bulkhead. Numerous private docking facilities border the access
channel to the south.
The Surf City Land Use Plan classifies adjacent waters as Conservation, and the adjacent high ground portion of
the project area as Developed. The waters of the AIWW, in the vicinity of the project site, are classified SA by the
Division of Water Resources. They are NOT designated as a Primary Nursery Area by the N.C. Division of
Marine Fisheries and they are CLOSED to the harvest of shellfish.
CAMA General Permits #62653 and #63115 were recently issued to the applicant on November 14,
2013 and December 11, 2013, respectively. The permits authorized maintenance excavation with the
existing channel leading into Harbor Sound/Waters Bay from the AIWW. The permits are scheduled to
expire on February 14, 2014.
PROPOSED PROJECT:
The applicant proposes to install six (6) channel markers and one "danger marker" adjacent to the dredged
channel in the Harbor Sound/Waters Bay access channel. According to the application package, four (4) red day
markers, two (2) green day markers and one "danger marker" would be installed adjacent to the Harbor
Sound/Waters Bay access channel. As proposed, each piling (8" piling) would contain a US Coast Guard
approved day marker with reflective tape. The four red markers would be installed on the north side of the
channel and the two green pilings would be installed on the south side of the channel. The "danger marker"
(yellow in color) would be installed along the south side of the channel between lots 3 and 4. As designed, the
four red markers would be installed opposite lots 1, 4, 8 and 10 of the Harbor Sound development and the green
markers would be adjacent to lots 1 and 9. In addition, an advertisement sign would be incorporated and displayed
from Channel marker #2. As proposed, the channel markers would be installed along the shallow side of the
dredged access channel. Post dredge water depths should average approximately -5.0', relative to Normal Low
Water (NLW). Because of the proximity to the adjacent piers and/or docking facilities, the exact positioning of
the channel markers should be installed to allow safe, un- obstructive access to and from the facilities.
10. ANTICIPATED IMPACTS
The installation of the seven markers would not result in permanent significant impacts to Estuarine Waters and
Public Trust Area. Minor increases in turbidity should be expected. The proposed locations for the markers do not
appear to pose a threat to navigation. However, should the exact location of any marker cause interference with
navigation to and/or from any of the existing private docking facilities, the applicant shall relocate the pilings to
the nearest un- obstructive location. As proposed, none of the channel markers would be located within the COE
right -of -way.
Submitted by: Jason Dail Date: 1/2/2014 Office: Wilmington
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G6vhpkC'i0n /Alle jt*7v4y,/ 20A/ RECEIVED
DCM N11LNiWGTON, NC
DEC o 213
UPUCITIONUr 1
Maier Development Permit
(last revised 12127106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
Project Name (if applicable)
q4r l- Sound
Applicant 1: First Name
i�1 `G
MI
MI
E
Last Name
Al
QQ
�L "
MI
Applicant 2: First Name
Last Name
MI
Last Name
PO Box
If additional eppticant % please attach an additional pages) with names listed
State
ZIP
Mailing Address
2 / l�
Phone No.1
/11
PO Box
Phone No. 2
- - ext.
City
rl
State
I ,
ZIP
2
Country
VS
Phone No.
ql)- A - A 74
ed.
FAX No.
- -
Street Address (d different from above)
tl
City
State
ZIP
Email
2. AgerWContractor Information
Business Name
Agent/ Contractor 1: Firfit Name
MI
Last Name
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
Y
PO Box
City
State
ZIP
Phone No.1
/11
ys G17l exL
Phone No. 2
- - ext.
FAX No.
Contractor #
Street Address (I different from above)
City
State
ZIP
Email
hda k4 V
tl
46�m
<Form continues on back>
RECF1V 7�D
DCM WILMINGTON, NC
DEC A0 2013
Form DCM MP -1 (Page 2 of 4)
APPLICATION for
Major Development Permit
3. Project Location
County (can be multiple)
Street Address
State Rd. #
Pem d&,
(% VC
1&*1d
S
Subdivision N
City
State
Zip
Z v d
G�
L-
2
Phone No.
Lot No.(s) (if any, attach additional page with fist)
P
I. Is the proposed project consistent with the applicable zoning?
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
n,&
A I C- W
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 OManmade ❑Unknown
t,
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
Ofes ❑No
work falls within.
C
4. Site Description
a. Total length of shoreline on the tract (R)
b. Size of entire tract (sq.ft.)
�os
3025-1)
c. Size of Individual lots) i
d. Approbmate elevation of tract above NHW (normal high water] or
SS
NWL ( a/ waterlevel)
(N many lot sizes, please attach additional page wr7h a list)
n ❑NHW or ❑NWL
e. Vegetation on tract
N/ e-
f. Man -made features and uses now on tract
,!
g. Identify and describe the existing land uses adiacent to the proposed project site.
homes
h. How does local government zone the tract?
I. Is the proposed project consistent with the applicable zoning?
(Attach zoning compliance certificate, if applicable)
�m p7enlv
I2fes ❑No ❑NA
J. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes [moo
k. Has a professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ❑No BAA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does ti Involve a ❑Yes ONo ❑NA
National Register listed or eligible property?
<Form continues on next page>
RECEIVED
DCM WILMINGTON, NC
DEC a 0 2013
Form DCM MP -1 (Page 3 of 4)
APPLICATION for
Major Development Permit
m. () Are there wetlands on the site? [Yes 0No
(i) Are there coastal wetlands on the site? 13Yes Mho
(iii) If yes to either (i) or (r') above, has a delineation been conducted? []Yes []No
(Attach documentation, ff evaflable)
n. Describe existing wastewater treatment facilities.
11A --
o. Describe existing drinking water supply source.
Ci
p. Describe existing storm water management or treatrr nt systems.
5. Actdvities and Impacts
a. Will the project be for commercial, public, or private use? BCommerclal
❑PubiidGovemment
r- 0 M ❑Pmate /Community
b. Give a brief description of purpose, use, and daily operations of the p ject when complete.
ntw1a idn *J aids
c. Describe the proposed construction methodology, Was of construction equipment to be used during construction, the number of each type
of equipment and where It is to be stored.
t l&114,�Ornll CV;:L plk(d WI
prlIn),
d. List all development activities you propose.
Av c'ids on p1l it,
e. Are the proposed activities maintenance of an existing project, new work, or both?
A-ew
f. What is the approximate total disturbed land area resulting from the proposed project?
11 Mf-
OSq.Ft or J]Acres
g. Will the proposed project encroach on any public easement, public acoessway or other area OYes o
❑NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
11 ht
I. Will wastewater or stormwater be discharged into a wetland? []Yes EA
[INA
If yes, will this discharged water be of the same salinity as the receiving water? ❑Yes []No
QAIA
J. Is there any mitigation proposed? pYes @No
[INA
If yes, attach a mitigation proposal.
<Form continues on back>
DCM WILMINGTON, NO
DEC �,u 2013
2U2,-S."B ."— ?..0 ,. a .fl-...:.. -,f.'c C' ' z— ., ieV - i, . ... --P -r,' 4 —t ..., — -,r;
Form DCM MP -1 (Page 4 of 4)
APPLICATION for
Major Development Permit
6. Additionallnformadon
In addition to this completed application form, (MP -1) the following r%ms 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 suffidently detailed to guide agency personnel unfamiliar with the area to the she.
d. A copy of the deed (with state application only) or other instrument under which the applicant claims tide to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A fist 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 JQ"� e S j�!)�� f A Phone No. --y
Address 71D Aalo9(i 9ye ,jip � t ltl��l�(�� ` O 344-25
Name Npr6CidnheS �/ Phone No. /�
Address 127 a, w %tG lam 1 jjX*1g 1 N_Y I� �� ZU � J-Lld 3a qY
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.
to 2 GSA Owe, lam,. e4-
T
h. Signed consultant or agent authorization form, if applicable.
i. Weiland 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.
1 7. Cerlication 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.
1 further certify that Pe information provided in this application is truthful to the best of my knowledge.
Date Print Name
Signature
Please indicate application attachments pertaining to your proposed project.
ODCM MP -2 Excavation and Fill Information ❑DCM MP -5 Bridges and Culverts
❑DCM MP-3 Upland Development
[3DCM MP-4 Structures Information
2 2 3 S•.. 'f' 1 Z?.a- ' 0', , -
RECEIVED
DCI n WILIMINGTON, NC
DLEC I � 2013
Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
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.
!. DOCKING FACIUMMAR/NA CHARACTERISTICS
a. (i) Is the docking facility /marina:
,Mmmerctal ❑Publ!dGovemment ❑Private/Communky
❑This section not applicable
b. () Will the facility be open to the general public?
(Byes ❑No
c. () Dock(s) and/or piers)
d. (i) Are Finger Piers included? []Yes [moo
() Number 1_
If yes:
(ii) Length L t'.�jt5'F i rt t,
(ii) Number
(iv) Width k _ /
(iii) Length
(v) Floating []Yes ❑No
(iv) Width
(v) Floating ❑Yes ❑No
e. () Are Platforms included? 0ifes ❑No
f. (i) Are Boali is included? ❑Yes dNo
If yes:
If yes:
(ii) Number --q
(i) Number
(II) Length -A
(u) Length
(w) Width ,.,L,_
(iv) width
(v) Floating Cafes ❑No
Note: Roofed areas are calculated from dnplme dimensions.
g. (1) Number of lips proposed
h. Check all the types of services to be provided.
�
❑ Full service, including travel lift and/or rail, repair or
(ii) Number of slips existing
maintenance service
❑ Dockage, fuel, and marine supplies
ITDocxage (wet slips) only, number of slips: 7
❑ Dry storage; number of boats:
❑ Boat ramp(s); number of boat ramps:
❑ Other, please describe:
I. Check the proposed type of siting: J. Describe the typical boats to be served (e.g., open runabout,
❑ Land cut and access channel charter boats, sail boats, mixed types).
❑Open water, dredging for basin and/or channel
❑Open water, no dredging required'
❑Other, please describe:
k. Typical boat length: I. (1) Will facil��yry be open to the general public?
�dYes ❑No
m. (1) will the facility have tie pilings? RECEIVED
Oyes ❑No DCM WILMINGTON, NC
(Ii) If yes number of He pilings?
DEC a u 2013
I t.!'T fns :i,C ,t, ,( -AS - -4 1����..1�kKu. �"CY3C TG� -e 2. Lt: 4t
2. DOCKING FACIUMMAR/NA OPERATIONS OSts section not applicable
a. Check each of the following sanitary facilities that will be included in the proposed project.
❑ Office Toilets
❑ Toilets for patrons; Number. : Location:
❑ Showers
❑ Boathokiing tank pumpout; Give type and location:
b. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste, fish offal and trash.
d. How will overboard discharge of sewage from boats be controlled?
e. 01 Give the location and number of 'No Sewage Discharge" signs proposed.
(I) Give the location and number of ° Pumpout Avallable° signs proposed.
f. Describe the special design, if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum products.
g. Where will residue from vessel maintenance be disposed of?
h• Give the number of channel markers and *No Wake° signs proposed.
I. Give the location of fuel- handling facilities, and describe the safety measures planned to protect area water quality.
j. What will be the marina policy on overnight and live- aboard dockage?
k. Describe design measures that promote boat basin flushing?
I. If this project is an expansion of an existing marina, what types of services are currently provided?
DCM WILMINGTON, NC
m. Is the marinaldoccing facility proposed within a primary or secondary nursery area?
[]Yes E3No DEC 20 20 13 `3
(Structures; r e m 3 ar 41
n. Is the marina /docking facility proposed within or adjacent to any shellfish harvesting area?
Oyes PfNo
o. Is the marina/docking facility proposed within or adjacent to coastal wetlands/marsh (CW), submerged aquatic vegetation (SAV), shell bottom
(SS), or other wetlands (WL)? If any boxes are checked, provide the number of square feet affected.
OCW O AV OSI3
OWL j4 one
p. Is the proposed madnaidocking facility located within or within close proximity to any shellfish leases? OYes 4NO
If yes, give the name and address of the leaseholder(s), and give the proximity to the lease.
3. BOATHOUSE (including covered lifts) J;3rfhis section not applicable
a. (1) Is the boathouse structure(s):
OCommercial OPublidGovemment ❑Private/Communky
fi) Number
(iii) Length
(iv) Width
Note: Roofed areas are calculated from drlpline dimensions.
4. GROIN (e.g., wood, sheetpile, etc. If a rock groin, use MP-Z Excavation and Fill.) Qfiis section not applicable
a. (1) Number
fi) Length
(iii) Width
15. BREAKWATER (e.g., wood, sheetpile, etc.) Zhis section not applicable
a. Length
c. Maximum distance beyond NHW, NWL or wetlands
Ilf
6. MOOITNG PILINGS 8Ad BUOYS
a. Is t e structure(s):
Commercial OPublidGovemment Ef'rivate/Communtty,
c. Distance to be placed beyond shoreline -7 0 _
Note: This should be measured from marsh edge, if present
e. Arc of the swing
7. GENERAL
b. Average distance from NW, NWL, or wetlands
OThis section not applicable
b. Number
d. Description of buoy (color, inscription, size, anchor, etc.)
RECEIVED
DCM WILMINGTON, NO
DEC 2 0 2013
L'E � ^:r'C L� ^i �e •: 2:... „ -g; �:G -sir "`.': r- }?" : 'h'tr_h "T'PC _C1c.SF<'v_tfn an.,14'sn'_:.F2 �_
Form D f4 (Stru.c ;turesy 4 of 41.
a. Proximity of structure(s) to adjacent riparian property lines
n/g
Note: For buoy or mooring piling, use arc of swing mduding length
of vessel.
b. Proximity of structure(s) to adjacent docking facilities.
4
c. Width of water body d. W�l depth at waterward and of structure at NLW or NWL
SaL 5
e. (i) Will navigational aids be required as a result of the project?
[lfes ONo ❑NA
(ii) if yes, a lain what type and how they will be implemented.
red d a✓keYs av1 i^ /yh�S /oft, o �'� ew, kwyac. cL M+a e -1 Z ,�eP.r, dti all 40d
N /4' � ', i , One lMaf;/ rd /dGt mkP yna. ln4- krMA -Aon, 4'n',&7 m4,/L
18. OTHER ❑This section not applicable
a. Give complete description:
%6 //-3
Date
la � 0/
Project Project Name
P%42
Applicant Name n
Applicant'Sk44tute
RECEIVED
DCM WILMINGTON, NC
DEC 2 0 2013
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CAMA /`)l DREDGE FILL
Te r
GENERAL PERMIT Y6
❑New AModification ❑Complete Reissue ❑Partial Reissue
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_
Affected a Cw
AEC(s): D OEA
❑ PWS:
NEW PTA ❑ ES D PTS
0 HHF ❑ IH - O USA ❑ N/A
❑ Fc-
Previous permit # Z-6 7
Date previous permit issued
07 �i • I'�oo
❑ les attached.
Project Location: County Pe,d!, �d
Street Address/ State Road/ Lot #(s)
Subdivision
CityC::,UtLF
Phone # ( )fir �ivBasin
Adj. Wtr. Body, ( le�.�f "� 50,o/3E> l (n4CA! /unk�
1
CAMIA / ®FiEC2�(E & F8[LB.
-�. i�E1@,I , �, PERMIT Previous permit #
' New ❑Modification ❑Complete Reissue ❑Partial Reissue 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 C' c:
❑ Rules attached.
Applicant Name AA �� �� Lt X fat -7'' - _ Project Location: County p �i L>E,2�
Address 2 if ) �Sv�LI Street Address/ State Road/ Lot #(s) 7� /C I <0 t,' LAN
City � v t v 1 c>j State ZIP - ' `2WA,$ jc tk L5 L A Ti 0 ; N,5
Phone # 6 IC Fax # L--) Subdivision ;tip
Authorized Agent ��LI'� f RdPJ ✓�,. City '5Vf'-F C'_ ( T -Lt ZIP z �`
Affected O Lw EW >PTA O ES O PTS Phone # f S4,5 'AN River Basin -
AEC(s): O OEA O HHF ❑ IH ❑ USA ❑ H/A
Adj. Wtr. Body :'01C 5C�-+ ,,%hnat M /unknl
O PWS: ❑ FC:
ORW: yes J9 PNA yes � Crit.Hab. yes Closest Maj. Wtr Body r� S i3N jJ
Type of Project/ Activity INIA 16 TEN A �iLi% LAtZ� V 1�{
(Scale:
Pier (dock) length - - -- - - - -- SaNC%% I r- - - -- ,- �- - • - -- -- - -�-
Platform(s) - _ - - - - -_-
-- i I- LA i I -j—
Finger pier(s)
Groin length L
number -� -- - - - -- - - -- - -- - - T
Bulkhead/ Riprap length ,- 1 _ -
avg distance offshore
max distance offs ore _- - -- _ . -- _ -- - - - = -I -?- - -- -- �-- -
Basin n
-- - _.. - -
cubic yards 1 +� t: ► r - - I -- 5 -
Boat ramp
Boathouse/ Boadift
Beach Bulldozing -- - - -- - -- - -.- - - -J I -�
Other
Shoreline Length
SAV: not sure yes no __--- - -__ -- -- -
Sandbags: not sure yes no --
Moratorium: n/a yes no
Photos: ___y4 ? - °O_ - - - - - - -- - -+- E- -- i
Waiver Attached: yes no - - -- -- - - - - -. _ —_- -
A budding permit may be required by: 5( • , L Ull� "�-
Notes/ Special Conditions'
vP * 7'.il- :r
t or Applicant Printed Name
Signature '''Pilepse read compliance statement on back o of permit�
Appli lion Fee(s) Checic #
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note on ` k
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River Basin rules.
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DEC 6' 0 2013
Per O Office ignature
Issuing Date Expiration Date
Local'lannmg Jurisdiction 7.over File fume
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