20052200 Ver 1_Complete File_20051214

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o
Jerry and Melanie Storey
311 Woodrow School Road
Murfreesboro, NC 27855
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 20, 2006
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 05-2200
Hertford County
Subject Property: Jerry, Storey Property
Chowan River [030103, 25, B, MSW]
Approval of 401 Water Quality Certification (GC3400) with Additional Conditions
Dear Sir or Madam:
You have our approval, in accordance with the attached conditions, to place fill material within or
otherwise impact 0.0074 acres', of non-vegetated wetland (river bottom) and shade 0.0241 acres of non-
vegetated wetland (river bottom) to construct a bulkhead, pier and platform as described in your
application received by the Division of Water Quality (DWQ) 401 Oversight/Express Review Permitting
Unit on December 14, 2005. After reviewing your application, we have determined that the Division of
Water Quality (DWQ) General Water Quality Certification Number 3400 covers these water impacts.
This Certification allows you to General Permit No. 198000291 when issued by the US Army Corps of
Engineers (USACE). In addition, you should get or otherwise comply with any other federal, state and
local requirements before you go ahead with your project including (but not limited to) erosion and
sediment control regulations and CAMA. Also, this approval to proceed with your proposed impacts
or to conduct impacts to waters as depicted in your application shall expire upon expiration of the
404 or CAMA Permit.
This approval is 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. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions.'! If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts, are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved (Units) I Plan Location or Reference
Non-vegetated wetland river bottom) 1 0.0074 acres filled; 0.0241 acres shaded DCM Field Investigation Report
401 Oversight/Express Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet! httn://h2o.enr.state.nc.us/ncwetlands
None Caro 'na
4tU P;
An Equal Opportunity/Affirmative Action Employer r 50% Recycled/10% Post Consumer Paper
Jerry and Melanie Storey
Page 2 of 2
January 20, 2006
2. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401 Oversight/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
3. Water Quality Certification
The proposed project must comply with all of the conditions of General Water Quality
Certification (GC) 3400.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification, shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved water
impacts), 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, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. 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 Cyndi Karoly in the Central Office in Raleigh at 919-
733-9721 or Kyle Barnes in the DWQ Washington Regional Office at 252-946-6481.
S'P ely4ek,P.E.
AlAWK/ Jm
Enclosures: GC 3400
Certification of Completion
cc: Doug Huggett, DCM
USACE Washington Regulatory Field Office
Kyle Barnes, DWQ Washington Regional Office
File Copy
Central Files
DMF Headquarters, P.O. Box 769, Morehead City, NC 28557
Filename: 052200JenyStorey(Hertford)401_CAMA
-* QA
? 2
0Q52200
North Carolina Department of Environment and Natural Resources
`Division of Coastal Management
Michael F. Easley, Govemor 1Charles S. Jones, Director William G. Ross, Jr., Secretary
MEMORANDUM
Ms. Cyndi Karoly
Env. Biological Supervisor
Division of Water Quality, Wetlands Unit
F d 1? Doug Huggett',!
Major Permits Processing Coordinator
Coastal Management Division
400 Commerce; Avenue
Morehead CityNC 28557
DATE: 12 December 2005
SUBJECT: CAMA Application Review
APPLICANT: Jerry & Melanie Storey
PROJECT LOCATION: Hertford County
M`
Respond to Doug Huggett
Morehead City Office
E ? ?-77
DEC 1 4 7005
DENdR - °v`iAI iris GI IALITY
WEPT--w aDa f,`!D STCii",'.1' Ti R F:RAg Cf!
PROPOSED PROJECT: Applicant proposes to construct a bulkhead, pier, covered platform, and
slope/grade the entire lot on property located at Lot No. 11 in the new Riversedge
Subdivision on the West Side of the Chowan River located off US Highway, 158 upstream
of the Chowan River Bri dge, near the Town of Winton, Hertford County, North Carolina.
Please indicate below your position or viewpoint on the proposed project and return this form by
9 January 2006. Please contact R. Kelly Spivey at 252-948-3853, if you have any questions
regarding the proposed pre'ect. When appropriate, in depth comments with supporting data are
requested. 7 j'i
REPLY This office has no objection to the project as proposed.
This office has no comment on the proposed project.
ice approves of the proposed project only if the recommended
are incorporated. See attached.
ce objects to the proposed project for re sons escribed in the
comments.
Date
W???RhnCarolina
)vatura!!y
94, Washington Square Mall, Washington, North Carolina 27889
Plane: 252-946-6481 1 FAX: [phone] Internet www.newastalmanaaementnet/
f
.1
1.
2.
3.
4.
5.
6.
7.
DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
APPLICANT'S NAME: Jerry and Melanie Storey
LOCATION OF PROJECT SITE: Hertford County
Photo index - 2000:145-1678,R-14 1995:N/A 1989:1(1-19),T-9
State Plane Coordinates - X: 2,606,300 Y: 972,800
Winton Quad (lower right corner)
INVESTIGATION TYPE: CAMA & State Dredge and Fill
I,
INVESTIGATIVE PROCEDURE: Dates of Site Visit - 3 November 2005
Was Applicant Present - No
PROCESSING PROCEDURE:'Application Received - 2 December 2005
Office - Washington
SITE DESCRIPTION:
(A) Local Land Use Plan -Hertford County
Land Classification From LUP - Conservation (water), Rural (land)
(B) AEC(s) Involved: Coastal Shoreline, Estuarine Water and Public Trust Area
(C) Water Dependent: Yes
(D) Intended Use: Private
(E) Wastewater Treatment: Existing - None
J Planned - On-site Septic System
(F) Type of Structures: Existing - None
! I Planned - bulkhead, slope and grade lot, pier, covered platform, future residence
(G) Estimated Annual Rate of Erosion: None Observed
HABITAT DESCRIPTION: [AREA]
DREDGED FILLED OTHER
(A) Vegetated Wetlands ?I
i
(B) Non-Vegetated Wetlands X326 ft2 1,050 ft2
River bottom bulkhead backfill shaded
(C) Other ±54,450 ft2
Uplands graded/sloped
(D) Total Area Disturbed: 5,500 ft2 (±1.27 acres)
(E) Primary Nursery Area: Nio
(F) Water Classification: 'B NSW
Open: NO
8. PROJECT SUMMARY: Applicant proposes to construct a bulkhead, pier, covered platform, and slope/grade the
entire lot.

r
December 1, 2005
To Whom It May Concern:
Enclosed is information for a CAMA Major Development Permit. This site (see map) is
located at the intersection of US 13 and Highway 158 in Winton, NC. This lot (lot # 11)
is in the RiversEdge subdivision on the Chowan River.
We are applying for a Major Permit because we will be disturbing more than one acre of
land.
RiversEdge Subdivision is a new subdivision located just outside of Winton, NC just off
of Hwy 158 West towards Murfreesboro, NC. This lot has been cleared of timber and the
stumps removed, except for a 75 foot buffer next to the Chowan River.
Enclosed is a copy of our survey, deed, drawings, location maps and a description of the
plans we are submitting.
Our plans are to slope the lot down to the river, install a bulkhead at the rivers edge, and
install a 75 foot pier with a 20x30 covered deck on the end.
DRAWL-- TGS
Page ONE ("AS IS") shows the survey dimensions along with the brink of the hill that
slopes approx. 30 feet down to the Chowan River. This 30 foot drop takes place in
approx. 40 linear feet.
Page TWO ("PROPOSED DEVELOPMENT") shows the proposed 3 to 1 slope, the
proposed bulkhead and the pier and covered deck along with other information.
Page THREE and FOUR show the proposed cross sections. The SIDE VIEW - SLOPE
shows the 3 to 1 slope. The PIER - COVERED DECK CROSS SECT. shows the pier
and covered deck. The pier will be 75 feet in length with a 20' X 30' covered deck on
the end. The BULKHEAD CROSS SECT. shows the location of the bulkhead with tie
backs, dead men, and bulkhead. The bulkhead will consist of 12 foot vinyl sheets with
eight feet below the ground and four feet above the ground.
1
The slopes on this lot';will be sodded or sprigged as soon as the work is complete with
irrigation installed.
Lot # 10 on the NW and the property on the NE of our lot are owned by the developers,
R.iversEdge LLC c/o Joe Murray Realty, PO Box 575, Ahoskie NC 27910
Thank youp for our time
q
Jerry an elame Storey
311 Woodrow School, Road
Murfreesboro, NC 27855
252-398-7468
Farm DC-M-NIF-2
A PI.1IA'sION
P
(To be completed by all applicants).
b. City, town, community or landmark
W2NToIV
1..&PPLICANT
a. Lando ormer:
Ne??RRy c?'MEi.?4NtE 5 702E
Address311 WOOPLOW SCHOOL fZ0110
City Ati '.F1ZFES13D1L0 State Al C,
Zip 2-7 S 5 Day Phone Z S Z -3 9 4 -72"
1^v ZSZ-398-4Z3R
b. Authorizadd AAgent:
Hams / ?/
c. StreVdress or secondary road number
LOT A'I IL1VE11,SEDR5u6, .TWST _
vT-F fi wy, ISS TOWARDS M41VQECS80Qt
d. Is proposed work within city limits or planning
jurisdiction? Yes. 1/' No
e. Name of body of water neazest project (e.g. river,
creek, sound, bay)CNDWA/ RI?UZZ
3. DESCRIPTION AND PLANNED USE
OF PROPOSED PROJECT
a. List all development activities you propose (e.g.
building ahome, motel, marina, bulkhead, pier, and
excavation and/or filling activities.
?WTALL 5utlcNEAD-SLcPE R1VCR.
Address
City State
5) 01: o F -CDT To A 3 +c 2 SL0 PF -
xns-'ALL. `I5' PIER k,,ITN ZOX30
DEe- 1K
Zip Day Phone b. Is the proposed activity maintenance of an existing
project, new work, or both? NEW WOU,
Fax c. Will the project be for public, private or commercia
-- - _... useL?-.PKIVATa
c. Projea name Cif any)
?tdJZ(y 4- M ELAnr) E -5101
NOT-: FfMNU WiU bl: issued u nave of L-Vimv er(s), cad/or
project =I e.
IW, LOCATION OF PROPOSED
PROJECT
:. Cou:lv HERTFORD
d. Give a brief description of purpose, use, methods c
construction and daily operations of propose
project. If more space is needed, please attar
additional pages. TO 13f LASED AS A ROME
L0'r - EXCAvATE A 30' NILL T&P A
3 +v 3- 5 L 0 P E To, THE CNcLIAM (11VE
&YD ZNST,AL.L. A VIVA- bNWE Ark
il'l' TN1; 514011E L)AlC. CXCA?ATtvnv
1?It.L 13F Do?vF v1TH A DoZ11M Am
F-XC,A?A?oil.. 34LKIJEAA AwaU t?1114
i P1EM AmO DECK W)LL 9E DONE
ti l-r)4 TJLADAnonrAL MFTHo05
Xd-14:5ed 0:41:5,
Form DCM-MP-1-
4. LAND AND WATER
CHARACTERISTICS.
a. Size of entire tract 2 s r- f t, e '
b. Size of individual lot(s). _ , 2jS ?GSLE
I.
c, ApproxEirnat0?elevation of tact above MHW or
NWL
d. Soil type(s) and texture(s) of tract
C1LAVFN 11- FlIVE SAn+Oy Lo AM
e. Vegetation on tract WDoOSLAIVO , P)/?C-
A,yo HA11.01?aoA i11 LE tl?,r C N T
f. ` Man-made fezmres now on tracts ?."
fl? m. Describe existirM rwastewater treatment facilities.
g. What is the CAMA Land Use Plan land
classification of the site? (Consult the 1o=1 land use pi=.)
W'( E?eipn Transitional
Developed _ Community
----- 6rai Other
ND r-6
n. Describe location and type of discharges to waters
of the state. (For example, surface runoff, sanitary
wastewater, industrial/commercial effluent, 'wash
down" and residential discharges.)
WLFAcE- RNNa FF
o:. Describe existing drinking water supply source.
,? '1V d NE
S. ADDITIONAL INFORMATION
In addition to the completed application form, the
following items must be submitted:
• A copy of the deed (with state application only) or
other instrument under which the applicant claims title
to the affected properties. If the applicant is not
h. How is the tract zoned by local government? clang to be the owner of said property, tben
y, - W1 forward a copy of the deed or other instrument under
i? which the owner claims title, plus written permission
i. the proposed project consistent with the applicable from the owner to carry out the project.
zonim'? _ Yes ! No
ttads zoning llarcce eerri1scac if ?p???) ® An accurate, } dated work plat (including plan view
,4 conT
•dIY'17'iYgS)-drS'T.(ii-to-src le.in bl?ce.
j, Has a professional archaeolggical assessment been ink -on an S 1/2" by .I V white paper.' (Refer to
done for the tract? Yes No Coastal Resources - Commission Rule., .7J.0203 for a
If yes, by whom? _ detailed description.)
k. Is the project located, in ,a National Registered
Historic. District or does. fit, involve a National
Register listed or eligible pr?perty?
yes. __V_ No
1, Are there wetlands on the (site? 'Yes No
.Coastal (marsh) mjA other
If yes, has a delineation been conducted? ,r?t
(,tack docurnrnt?uion, tj
,I
k,
Please note that original drawings are preferred and
only high quality copies will be accepted. Blue-lin.,
prints or other larger plats are acceptable only if az
adequate number of quality copies are provided bl
applicant. (Contact the U.S. Army Corps o
Engineers regarding that agency's use of large
drawings.) A site or location map is a part of ph
requirements and it must be sufficiently detailed t
guide agency personnel unfamiliar with the area to to
Revised 0319.5 i
;corn, DCM-'-Y1P-1
site . Include highway or secondary road (SR)
numbers, landmarks, and the like.
TO ENTER ON LAND
A Storm-mater Certification, if one is necessary.
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. Upon signing this form, the applicant
further e £A3F 4E c notice has been provided.
Nor: e 9a SDE 1%urkaA-r RSALTy
S"IS•?NOSKI?. N? 2791
Address PC' 139')(
Phone 252.•332- 4464
Nz ne
Address
Phone
Norris
Address
Prone
A list of previous state or federal permits issued for
work oa the project tract. Include permit numbers,
permittee, and issuing dates.
* A check for $250 $400/ 475 made
payable to the Departmen nvironment &
Natural Resources (NCDENR) to cover the
costs of processing the application.
414\4llsigned AEC hazard notice for projects in
oeeanfiont and inlet areas.
• ?A statement of compliance with the N.C.
E,-ivironmertaI Policy Act (N.C.G.S. 113A - I to
10) If the prcjecL involves the expenditure of public
f r ds or t:5-- of public 1? ds, at''ach, a stat,eme-ut
do:umeriting compliance with the NortL Carolina
znviro ??::e;:t=1 Policy Act.
.6. CERTIFICATION AND PERMISSI01
I understand that any permit issued in response to the
application wi11 allow only the development described i
the application. 7be project will be subject to wnditior
and- restrictions contained in the permit.
I certify that to the best of my knowledge, the propose
activity complies with the State of North Carolina
approved Coastal Management Program and will t
conducted in 'a manner consistent with such program,
I certify that I am authorized to grant, and do in fac
grant permission to representatives of state and feder
review agencies to eater on the aforementioned lands i
connection with evaluating information related to th
permit application and follow-up monitoring of d
project.
I further certify that the information provided in tt
application is truthful to the best of my knowledge.
This the _o day- of , 2005
3'Eftft,y S 710 REy
Print Name M15LAm19 5702Ey
Signature
Lm%dovm r or AuAorized Agent N
Please indicate attachments pertaining to your propos
project.
DCM MP-2 Excavation and Fill Information
DCM MP-3 Upland Development
7DCM MP-4 Structures Information
DCM MP-5 Bridges and Culverts
DCM MP-6 Marina Development
NOTE: Please sign and date each attachment in
space provided at the bottom of each form.
400 copies of this public document were printed at a total cost of $52.48 or $ .13 per copy.
R_y:sedz c:1'
l
I
Form DCM-W-2 .
I
__ - - ..?.... ? i
AND FILL
(Except bridges and culverb)
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 protect'
Describe below the purpose of proposed excavation or
fill activities. All values to be giver!. in feet.
Average FUM
E*ft pr4ect
I A
Access
channel
cA(Irw) or (k)") .
Cans! ...
Boat
basin
Boat
ramp
Rock
groin
Rock
breakwater
Other
(Excluding
shoreline
stabUlzation)
Length Width '! Depth Depth
.<u
1. EXCAVATION
a. Amount of material to be excavated froth below
MHW or NWL in cubic yards'
b. Type of material to be excavated
c, Does the area to be excavated include coastal
wetlands (marsh), submerged aquatic vegetation
(SAVs) or other wetlands? ' Yes No
d. Highground excavation in cubic yards
2. DISPOSAL OF EXCAVATED
MATERIAL I'
N
a. Location of disposal area
b. Dimensions of disposal area
c. Do you claim title to disposal area?
Yts . 'No
If no, attach a letter granting perinissrion from the
owner.
d. Will a disposal area be available for future
maintenance? Yes No
If yes, where?
Revised 03195
Facet DC,N1•MF-2
G• (1) Amount of material to be placed in the
{mesh}, SAVs or otitrs wetlands? water
y? No (2) Dimensions of fill area
f. Does the disposal include any area in the water?
Yes _ No
(3) Purpose of fill
3. SHORELINE STABILIZATION
a. Type shoreline stabilizafwn
Bulkhead' Riprap
b. Length _ 16 3
c. Avenge distT w to ard of :v HW or NWL
d. RSaximu S dish ? e, wwawxward of MHW or NWL
e. Shoreline erosion during preceding 12 months .
Al AT, c?ti5E9,1V01)
?Soirce of ?orma•?1
H E Trap mat?iat -
f. TAN bulkhead or
Amount of fill in cubic yards to be placed below
water level t1 p
(1) Riprap
(2) Bulkhead backfilt CUBIC (f?5
h. Type of fill material -6 A/VD ! CLAD
gr"1 E LOT .(afS
i. Source of fill material
r, P ? t o
4. OTHER FELL ACTIVITIES /
(Excluding Shoreline Stabilization)
a. Will fill material be brought to site?
Yes No
b. Will fill material be placed in coastal wetlands
(marsh), SAVs or other wetlands?
Yes No
If yes,
(1) Dimensions of fill area
(Z) Purpose of fill
S. GENERAL
a. How will excavated or fill material be kept on site
and erosion controlled? 134LK14 66 VIL L Q1;
?NST/?Z?Ea (3EFOf?.E 6AGK P)LLINIr
AFTER T-11.WA1b- SDD ANo
=ut i UMA?, oN 01t.L- ISE 1N1YALLED
b. What type of construction equipment will be used
(for example, draglinei backhoe, or hydraulic
FxCA?ATo(L ^ 13AMHOL 022/sk
c. Will wetlands be crossed in transporting equipment
to project site? Yes 4G No
if yes, explain steps that will be taken to lessen
environmental impacts.
%TsRRy C? MSLANl_e STORE
Ikstat ed Name
?z 1 5
Date
$ TLRd 03195
Form DCM-MP 3
UPLAND
DEVELOPMENT
(Construction and/or land disturbing activities)
Attach this form to Joint Application for CAMA Major h.
Permit, Form DCM-MP-1. Be sure to complete all
other sections of the Joint Application that relate to this
proposed project.
a. Type and number of buildings, facilities, units or
structures proposed ONE FuTWU
RES)DE.,v71AL Ho/nlr= i.
b. Number of lots or parcels 0Al ?
c. Density (give the number of residential units and the
units per acre) DANE u1y19'- 1,15 Ae-r E.
i
d. Size of area to be graded, filled or disturbed
including roads, ditches, etc. 1,1.5 ?CRF_
e. If the proposed project will disturb more than one
acre of land, the Division of Land Resources must
receive an erosion and sedimentation control plan at
least 30 days before land disturbing activity begins.
If applicable, has a sedimentation and erosion
control plan been 4ubmitted to t pDivision of Land
Resources? _ Yes No
If yes, date submitted
f. List the materials (such as marl, paver stone,
asphalt, or concrete) to be used for paved surfaces.
1 L91y9 PrUPPOSE0 AT TN 3 T/M E
g. Give the percentage of the tract within 75 feet of
MHW or NWL, or within 575 feet in the case of an
Outstanding Resource Water, to be covered by
impervious and/or built-upon] surfaces, such as
pavement, buildings, rooftops or to A e used for
vehicular driveways or parking,
Projects that require a CAMA Major Development
Permit may also require a Stormwater Certification.
Has a site development plan been submitted to the
Divisiop of Environmental Management for review?
Yes _L,,"' No
If yes, date submitted
Describe proposed method of sewage disposal.
SEPTIC TAI?K
Have the facilities described in Item i. above
received state or local approval? V &S
(Attach appropriate documentation)
k. Describe location and type of proposed discharges to
waters of the state (for example, surface runoff,
sanitary wastewater, industrial /commercial effluent,
"wash down" and residential discharges).
.SiMPo9CE TLNNCFF Mo^ RI?C-n,
SIDE OF- t_oT
1. Describe proposed drinking water supply source
(e. . well, communit?yy, public system, etc.)
tau J3LIL S y57EM
m. Will water be impounded? Yes -tef'-No
If yes, how many acres? __A,fA
n. If the project is a oceanfront development, when
was the lot(s) platted and recorded? IV /A
fE R R. OL M E L Av 10 5?oaE
li sect Name
[(I r - i
S1gII1$ture ,
Date
Revised 03/95
Form DCR1-INiR4
STRUCTURES
(Construction within Public Trust Areas)
Attach this form to Joint Application for CAMA Major
Permit, Form DCM-'.kiP-1. Be sure to complete all
other sections-of the Joint Application which relate to
this proposed project.
,VIA
e. Mooring buoys
(1) _ Commercial -Community _ Private
(2) Number
(3) Description of buoy
(Color, inscription, size, anchor, etc.)
a. Dock(s) and/or Pier(s)
(1) _. Commercial -Community Z Private
(2) Number 1. ' .
(3) Length (4) Width of water body
(4) Width (6) Distance buoy(s) to be placed beyond
(6) Finger Piers Yes f No shoreline
(i) Number A A
(ii) Length f. Mooring structure (boatlift, mooring pilings, etc.)
(iii) Width
(6) Platform(s) V Yes No
(i) :dumber l o p1o M Rpd9
ii) Length th 10 ?9-1 #4 o
n Number of slips proposed g.
(8) Proximity of structure to adjacent riparian
property lines SD FEET
(9) Width of water body _ LJ D O Tt-E ET
(10) Water depth at 1vaterward end of pier at
MLW or NWL - 3 0 PE ST

bN oathouse (including covered lifts)
(1) Commercial Private
(2) Length
(3) Width
VIA

,
Groin
c,
(e.g. wood, sheetpile, etc.)
(1) Number
(2) Length(s)
Y1
d
%akwater (e.g. wood, sheetpile, etc.)
(1) Length
(2) Average distance from MHW, NWL or
wetlands
(3) >4iaximsm distance beyond MHW, NWL or
wedands
(1) _ Commercial -Community - Private
(2) Number
(3) Length
(4) Width
Other (Give conplete description)
JERNY J- MVZANIE 5?oRF,
Appkant r Project Name
t
12-?- oS
Date
Revisf3 03195
64AS IS"
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311
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