71742D - Provost

CAIVIA / DREDGE &FILL re-�s �.I9 No 71742 A B C D
GENERAL PERMIT Previous permit # 70 sz f O
❑New ]Modification KComplete Reissue ❑Partial Reissue Date previous permit issued 7 rt Z o 1$
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 I SA NCAC 0 7 14 • 1 1 0 O
❑ Rules attached.
Applicant Name L Cr PQF �/y �-r & ILL IAM hr-/V on/ Project Location: County 1�r Li{�s�niuvr�
Address Z S TLAND D;Zz Vr_
City WR,C,�1rsyI��c VCACN State ALC_ ZIP 2 84 F0
Phone # (11 ) 607- F905 E-Mail /J IA
Authorized Agent MARK C L C M E N-rr
Affected ❑ cw %Ew )ePTA )DES OPTS
AEC(s): ❑ OEA ElHHF ❑ IH ❑ UBA ElN/A
❑ PWS:
ORW: yes / io PNA yes /
Street Address/ State Road/ Lot #(s) ME
Subdivision
City _A.
ZIP SA ter-
/1 Phone # (`I 10 ) 2 7 0 - `I l 1 o River Basin C F R
Adj. Wtr. Body Ko-rT r C-+t, n/.vr - nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicants Printed Name
Signature Please read compliance statement on back of permit
*400 4qq 3
Application Fee(s) Check #
IG irP_ MC CMftV
Permit Officer's Printed Name
Signature
1/9 l 1 F 3/R /19
Issuing Date Expiration Date

`7 V► Y 'M IvtGC q by'5'v411� III
i], c MA /'DREDGE & FILL �i'a?)F it J 4 Z� I R No 70525
F di NERAL PERMIT Previous permit# A B C
;XNew 'Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As auth6rizecrby the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC c) 0
LEE PR F V i ❑ Rules attached.
Applicant Name Wif+!- IA MProject Location: County w A.yo VeR
Address' -JCse.AA/O D(1\V C Street Address/ State Road/ Lot #(s)4-,t y.Str A,*Jlp Lp.
City yveiG Tsylt.Lc c.ACN stateZIP Zg48�
Phone # (q 19) (p0 % -905 E-Mail /V LA Subdivision
Authorized Agent MARK Cwwt"nt-rc P6A C-rMcnlTs MAR1i4r_ Ci WRIGNTSVII.L-c- FEAC ZIP e-4 Kcs
oNj-rRue-nc" -T is r�r
Affected ❑ Cw XEW APTA [ $S 1 P s pone # ( 910) 2-10 - g I10 River Basin C F R
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body M oTT s C N A ,✓,v E L_ (nat /man /unkn)
yes
ElPws: A 1 W W
ORW: / P� PNA yes / Closest Maj. Wtr. Body no
Type of Project/ Activity 12 PLACE XIS 9"t.IL141 Al) WATEfi ijARa
0� C► R 9-r n/ T A I, i raw m r­n/-r (Scale: j
Pier (dock) length 1
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
;Iiiiprap length ± 4
distance offshore Z
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
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Shoreline Length —
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SAV: not sure
yes
no
Moratorium: n/a
yes
no
Photos:
yes
no
Waiver Attached:
yes
no
A building permit maybe required by: / aw f OF 14R1G H i 3VIu./ C - AC jj ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions h'7 N It p0 AND II A1,1. oTN CR Lo c-AL S-rA-fC 11.40
FAD L Rr;C-,ULA- iwV S APPLY LIAVT5 Dic 15-r1.RBAIVCr- 1-IM1Tro ice:
!'. / , . ...� .....� ♦ .► _ is v 1 .► w ,.
MARK CLT- s
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
0 400, DO .4744
Application Fee(s) Check #
`IL£R Mc C�I,�IIzF
PermitOffice�ted Name
/ ,� �C-
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Signature
7,9 /2�►
Issuing Date // Expiration Date

Letter of agent
I. Nhlham 1.- Henson III. 1 a.e retained Mark (lcments DAA. Clen.cnts Marine
Construction Inc, 41 make applicatirm tra am and all permits necdrd to.un construction
on the work requested for , rur property or pnKrrttes.
Hh allowing W. IL lenient to ma►c such apphcatu.n. I do urtderst&xl that thr.% wdl in no
war rel iere me of any obligations to pertivnr all work according it, the building codes of
%orth Carolina. CAM.A. 11%Q or am other suit and or awntr ordfrances.
Nilham I licnscsn III
919.607.8905 17 Mar ]ulg
RECEIVED
DCM WILMINGTON, NC
i U N 0 6 ('!]18

Leger of agent
have retained Mark Clements DBA, Clements
Marine Construction Inc, to make application for any and all permits needed to start
construction on the work requested for our property or properties.
By allowing Mr. Clements to make such applications I do understand that this will in no
way relieve me of any obligations to perform all work according to the building codes of
North Carolina, CAMA, DWQ or any other state and or county ordinances.
'W"'q
Pft
Signature
111, 111*- Y� �7 _ _ _-date
Contact information

i . A I
RECEIVED
DCM WILMINGTON, NC

Postal
CERTIFIEDo RECEIPT
cc
Domestic
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WR, TByI E: E; R ;ACF(r NC 8480
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Certifled Mail Fee e
$3.45
0443
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Extra Services &Fees (check box, add /ee as $!e)
❑ Return Receipt (hardcopy) $ 1 i �11
Il$
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El Return Receipt (electronic) $ Sri - tl- OCL,
.postmark
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❑ Certified Mail Restricted Delivery $ i r i 1 i�
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❑Aduft Signature Required $ xf
❑Adult Signature Restricted Delivery $
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Postage
$0•�I-I
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Total Postage and Fees
$6. 7;1
f 116 ja 111 8
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Sent To ,( �`4)
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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
9590 9403 0737 5196 1756 28
2. Article Number (Transfer from service label)
7016 2710 0001 0137 7388
PS Form 3811, April 2015 PSN 7530-02-000-9053
A. Si na re
X " ❑ Agent
Addres
B. eceived by (Print Nam) Da of eliv
s" f ,� ,� I6,
D. Is delivery address dill nt from item 1?1 ❑ Yes
If YES, enter delivery address below: Z-No
3. Service Type
❑ Adult Signature
❑ Priority Mail Express®
El Adult Signature Restricted Delivery
❑ Registered Mail -
❑ Registered Mail Restricted
A'Certified Mail®
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfirmationT
" Insured Mail
❑ Signature Confirmation
Insured Mail Restricted Delivery
Restricted Delivery
(over $500)
Domestic Return Receipt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I owr property adjacent rr, Gf//'1//1 s
property located a'
/ �� �� J (Name of Property Owner)
_ _ � c! �j'1�.e�
G, (Address, Lot, Block oad.ellc
In fj/rllt� N C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below. the development proposed at the above
location
I have no objection to this proposal.
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier. dock. mooring pilings, boat ramp. breakwater. boathouse. lift. or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
— ! do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
(Property Owner Information)
Phnt or Type Name
Marling Address
CityiStateZip
Telephone Number; emar/ address
1 !, u. —
Valid for one calendar year after signature'
(Adj nt Pr perty Owner Information)
si-14S�O� l�� Qizcz�s % t Ttr
y' Prn r
Mailing Addres,
Telephone Number i smart addiless
f Revised Aug. 201
RECEIVED
DCM WILMINGTON, NC

Date Received
Date
DeposNed
Check From
Name of Permit Holder
Vendor
Check Number
Check amount
Permit NumberlComments
Receipt or Retun&'Reallocated
Colurmi
Columns
Columns
Column4
Column5
Co1umn6
Co/umn7
Co1umn8
Column9
7/24/2018
7/24/2018
7l2412018
712412018
7124/2018, _
7/24/2018
7/24/2018
Clements Marine Construction, Inc.
Logan Marine (1 of 2)
L an Marine (2 of 2)
HELMS 2 0 LLC/Lane Helms
Salt 8 Light LLC _
Maritime Coastal Construction LLC _
Dane R. Vertefeuille
Custom Built Homes of the Carolinas LLC
Joel Klass Mone Order
William Benson First Citizens Bank
Nevin Carr Coming Federal Credit Union
Nevin Carr _ Coming Federal Credit Union
David P and Bevedy Delaney BB&T
William and Sharon Raw_ ding .CresCom Bank
RayJohnson CresCom Bank
Dane Vertefeuille BB&T
Donnie Pritt First Citizens Bank
Robert Gamer WU Mone Order
4744
$ 400.00
GP 70525D
TMc rct. 6830
PA rct. 6812
6271
$ 200.00
GP 70633D 1 of 2
6252
$ 400.00 GP 70533D 2 cf 2) _ _
$ 200.00 GP 70549D
$ 200.00 GP 70575D _
$ 200.00 GP 70545D
$ 200.00 GP 70532D
$ 600.00 GP 70569D
200.00 1GP 70550D
PA rct. 6812
TMc rct. 6834
SS rd. 6112
1290
1387
2695
TMc rct. 6833
1146
TP rd. 6191
JD rct. 6926
BS rct. 6800
7/24/2018
1002
7/24/2018
17-770488833

D9b Raedod
Deft
Check From Name
Name of PerrNt Holder
Vendor
Check Number
Check amount
Permif Numbe Xommenfs
Race! t or Refun&Rea9ocafed
cokf l
cohNnn2
Cokn 3
CokmW4
Column5
Column6
CokNM7
Columnd
Column9
111912018
B and B Marine Construction Brian Shirtliff
Clements Marine Construction Inc Lee Prevost and William Benson
Wells Fargo _ _
First Citizens Bank
_ _ 1972
$ 400.00
400.00
GP #72231 D _ _ _
GP #71742D
JD rct 6955_ _ _
TMc rct. 7301
11/9/2018
j- 4993