72734D - Shakesspeare

�^ -CAMA / _ - DREDGE & FILL No. 72734 A B C D
GENERAL PERMIT Previous permit #
__.New Modification Complete Reissue Partial Reissue Date previous permit issued
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 15A NCAC
Rules attached.
Applicant Name - - Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State__. ZIP -- - -
Phone # ( ) - _ - E-Mail -_ _ - Subdivision
Authorized Agent City _ ZIP -
Affected CW EW PTA :'ES PTS Phone # ( ) — River Basin
OEA HHF IH UBA N/AAEC(sj: Adj. Wtr. Body _ _ - - _ (nat /man _unkn)
PWS:
ORW: yes / no PNA yes no Closest Maj. Wtr. Body -- _ -
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) _
Finger piers)
Groin length
number
Bulkhead; Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse;' Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n,'a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
i Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit'*
Application Fee(s) Check #
(Scale: ) I
See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Issuing Date Expiration Date

Address__ 9_yf 7
City_ State v%% ZIP22_e15_
Phone # ($�/} ,�f �f b rV �E--Mail
Authorized Agent eeeie 1.
Affected Cw )�Ew ),+,TA j`ES PTs
AEC(s): OEA HHF IH UBA NIA
:-
PWS
ORW: yes / no PNA yes / no
Type of Project/ Activity
Gw
Street Address/ State Road/ Lot #(s)_
SubdMsision
City /I�.h�lff' ZIP
Phone # ( ) _ River Basin W�ie O9�
Adj_ Wir- Body �� W (na /man Junkn)
Closest Maj. Wtr. Body �9/ 4")v41 -- - - ---- ---
P er (dock) length
Fixed Platforms!
Floating Platform(s)
Finger pier(s)
Groin length
number
B rlkhea ip-p length
(Scale: / ,'3L,) / )
SK
avg distance offshore
max distance offshore
1
!
LOP
Basin, channel
/
cub- yards
Boat ramp
Boathouse/ Boadift(d/S
f�.�
4 O
I
}
L'� n e�v�
Beach Bulldo g
�N�k���yp�
�oilg
c'r
�r
Other
CQ,e f
Exu��y�
Shoreline Length
SAV: not sure yes n�
Moratorium: Na yes <
Photos: IL3�17 no
Waiver Attached. yes ( -
t
A building permit may be required by: pfi /Y.l%r%/Q CC/u/ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction /� Yp , J f
Notes/ Special Conditions %�-EC %�C� %�L/ 1 p C Lf%%1�(� Gt%%f✓�D �{' �9LL W e! L%o�5,
, -v/,
Agent 'need Name
Signs ure `a Please read compliance statement on back of permit "
Application Fee(s) Check #
Perr: f is'srinted Name
Signature
30 �
IS ng te/ _
0°/9-- -
Expiration Date

Letter of agent
I i .,.� �,� }!_,.i.((., ,.k.�_t hasc retained Mark Clements DHA, Clements
Narinc Cbnstmction Inc, to kc application for any and all permits needed to dart
construction on the work requested for our property or properties.
By allowing Mr. Clements to make such applications ( do understand that this will in no
way relict c me of any obligations to perform all work according to the building codes of
North Carolina, CA MA. DWQ or any other state and or county ordinances.
Print
Stgnaturc
date
Contact information
RECEIVE®
AN 14 2019
DCM WILMINGTON, NC

Adjacent Riparian Property Owner Notification / Waver
Form
Name of individual applying for the permit: j roe
Address of property: LLo j 00`7 b tFe (l gal i c:.
s h a. kc 1010 r'P _
I hereby certify that I own property adjacent to the above referenced
property. The individual applying for this permit has described to me
(as shown on the attached drawing) the development they are
proposing. A description or drawing, with dimensions, should be
provided with this letter.
I have no objections to this proposal
If you have any objections to what is being proposed, please write the
Division of Coastal Management, 400 Commerce ave., Morehead City,
NC 28557 or call [phone] within 10 days of receipt of this notice.
No response is considered the same as no objection if you have been
notified by Certified Mail.
Waiver Section
I do understand that a pier, dock, mooring pilings, breakwater,
boathouse, lift or sandbags must be a minimum distance of 15' from any
area of riparian access unless waived by me. (If you wish to wave the
setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I do wish to waive the 15' set back requirements
�- Signature
�.„� �, Print Name
SJC �/Z C/0g0 Telephone number with area code
Date
14

%djacent Riparian PropertN 0%%ner \otificatio�n cr
Farm
Name of indi%ideal appI\ink, for the permit:, c, ' r._ ^ =
\dare,, of propert\
I herch\ certif% that I oN\ it pr•opertN adjacent to the abo%e referenced
pr•opertN. I he indi\idual appl\in- for this permit has described to ntc
ias •tio\%n on the attached dra%%ina) the de\elopment the\ are
proposing. A description or dra%%ing. %%ith (Iimensions, should he
pro% ided NN ith this letter.
i I ha\ e lit) objections to this proposal
If \ou ha\c an\ objections to -*\hat is being proposed, please N%rite the
Di\ is ion of Coastal NI anat_jemcnt, 400 Commerce a\c.. Morehead Cit-.
`C 28�;57 or call (252) S08-2808 �sithin 10 da\s of receipt of this notice.
No response is considered the same as no objection if you ha\e been
notified b\ Certified Mail.
\\ ai\ el- Section
1 do understand that a pier, dock, mooring pilings. break%%ater,
boathouse, lift or santlimas must be a minimum distance of 15' from an'N
area of riparian access unless Naked bN me. (If }ou Nsish to �%a\e the
setback. you must initial the appropriate blank beloi%j
X•. I do %,isit to N%aise the I5setback reyuircment
1 do %%kh to N%ai%c the 15' set back requirements
;{ ! ti2S Print Name
aU?1 Div -� S�tS Telephone number N%ith area code
Date
:1jti'7EIVED
14 2019
"+ -ON, NC

v E D
...:. 'i. -70�
- , i J,;1i NG i , NC

Date Received
Dale De shed Check From (Name
Nanre of Permit Holder
Vendor_ _
Check Number
Check
emounl
Penn/t NumDenCommenb
Ravel t or ReIunWRea6ocalad
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