66569D - Pippin

!CAMA / ❑ DREDGE & FILL
1ENERAL PERMIT '
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
•ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_
1),
Previous permit #_ 4
Date previous permit issued
1 -
❑ Rules attached.
t Name
AM � /t Project Location: County
;? 9 . Street Address/ State Road/ Lot #(s)
7P bJ l oo State r✓L ZIP 2? .. ; t y. �, to A, l/
2-7 E-Mail Subdivision
ed Agent l - LK4 s IYllt�:i4 %�DH<:<. City ZIP �/ 1
❑ CW /IEW >tZTA ElES ❑ PTS
ElOEA ❑ HHF /❑ IH ❑ UBA ❑ WA
❑ PWS:
yes / 'no PNA yes ,/' ng7
Project/ Activity
:k)length
itform(s)
igth
nber
i/ Riprap ngth
distance offshore
x distance o A hove
cannel
sic yards
ip
se/ Boatlift�
Adozin TT
e Length O
not sure yes no
ium: n/a yes
Phone ## j---- River Basin
Adj. Wtr. Body F r
Closest Maj. Wtr. Body
(Scale: /Yr.
1
kttached: %yes' ] no
ng permit may be required by: �C�j�SG+�C ,U F
xyk. , ❑ See note on back regarding River Basin r
Local Planning Jurisdiction)

NC Division of Goal#al:ftt, Habitat Impact c®spa er
I.
plicant: OVA
ts'
scribe elow t7HABI T disturbances for the application.
I values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated fim
DISTURB TYPE Disturbancetotal disturbance. Disturbance disturbance.
abitat Name Choose One ' includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and)
restoration or and/or temp restoration or temp impact
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑ `
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑.
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

Letter of agent
l ���1i' ` ^� �'% N i" have retained Mark Clements DBA, Clements
Marine Cons ction Inc, 14 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, LAMA, DWQ or any other state and or county ordinances.
Print name
Signature
date 1�d
Contact information
RECEIVED
DCM WILMINGTON. NC
MAY 0 9 2016

CERTIFIED MAIL - RETURN RECEIPT REOUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
• f
Name of individual applying for the permit:_ a�
Address of property:
(Lot or street#, street or rood)
(City & County)
C. —
I hereby certify the 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 whit this letter.
f✓ I have no objections to this proposal
If you have 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 the notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags 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.)
�Pe 7114i�0i do wish to waive the 15' setback requirement
I do not wish to waive the 15" setback requirements

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual appl} ink for the permit: 1 is sl—%g t,
Address of property: Vk;a 4 ' --
(Lot or street#, street or rood)
_UOVef
f
t-cam
(City & l ounly) i
I hereby certify the 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 whit this letter.
'/ I have no objections to this proposal
If you have 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 the notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags 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.)
l�l do wish to waive the 15' setback requirement
I do not wish to waive the 15" setback requirements
Sigl cure \ D to

i3A► K,5 cNanne-C,
?; IN
1!i 22. CAr0,\,!1 w 61J .
z8yL/3
RECEIVED
DCM WILMINGTC
MAY 0 9 2016