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Home My WebLink About67987D - KlingenburgerCAMA / 'DREDGE & FILL / "';t A B / Previous permit # N >,ENERAL PERMIT New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued 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 tJ 7 14 - I l I `= 7ules attached. Name t1 � �i'S �� g ElU dlLc . Pproject Location: County N (/l'i� G V-( iMa SCE XjAd,(A,, Street Address/ State Road/ Lot #(s) /V ( L iM / State WL ZIP 28"If i i "��'�1^ voy, fl/Q )cnU —1,7-q ( E-Mail ed Agent ❑ cw R w �VPTA ;OS ❑ PTS ElOEA {❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: Subdivision City N L 14A ZIP ZK4 Phone # ( "T--- River Basin Adj. Wtr. Body Ok�G-j e - at r Closest Mai. Wtr. Body Y1�1(��UN�- yes PNA no ' Project/ Activity L( (A C.e' � 9% � � � 44 (Scale: f' _ :ngth tuber / d'>prap length; g distance offshore - 114— ax distance offshore hannel bic -np ise/ Boatlift -ie Length - /-- l G D not sure yes / —Y rium: n!a yes � � E.. N yes Attached: yes I ^ ling permit may be required by: / v [7X,2❑ See note on back regarding River Basin NC iCiwision at �fAi��'J�Clf1 .��1a,�us 9�Glp3p aSa3 xasa Ro:w..... .. - 1plicant: �► (�1/C1nl S `i (Ir . i de: / - hcation. :scribe below the HABITAT disturbances for the app.' .. I values should match the name,.and units of measurement found in. your Habitat code sheet. . TOTAL Sq: Ft, 7Excludes . TOTAL Feet FINAL Feet (Applied for. (al (Applied for. (Anticipated fina Disturbance total Disturbance disturbance. DISTURB TYP1G includes any total includes. Excludes any tbitat Name Choose Oneanticipated any anticipated restoration andkrestoration or and/otemp restoration or temp Impact ternim acts impact amount) tern im acts amount ❑ Fiil �nth❑ Other ❑ Dredge Dredge ❑ Fill ❑ Both . ❑ Other ❑ Dredge El Fill ❑ . Both .❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑. Both ❑ Other ❑ Dredge. ❑. Fill ❑ : Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑• Other )ayment Proccessing Confirmation Date Received 1/3/2017 :heck From (Name) Clements Marine LLC Name of Permit Holder Terry & Chris Kingenburger Vendor First Citizens Bank Check Number 4299 Check amount $400.00 Multiple Permits No Major/Minor Permit Number/Comments GP67987D Receipt or Refund/Reallocated JD3528D Letter of agent nu ��► 0 600� C (C:TIV__ qaw�-cz -4 C�L,� Lz_ft� I G�� 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. Aarn�e S C P 'nt name _q! l�lY) / 10 date Contact information c%" AD ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ( ame of Property Ow er) property located at (Address, otBlo k, Road, etcy� on a ['reed in Rez ( 416m'K C 0 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) W woe v— G ono-6a F Ma3c� GayJ„� /Ve ZyV// 8I C13 Ao 'r Ex►.�F,r� �ea�aQ-i T raQlp,�e. e- Ta +a of Jt 110 z 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.) /A /— I do wish to waive the 15' setback requirement. 1— I do not wish to waive the 15' setback requirement. (Property Owner Information) CxG S�zatzue Print or Type Name �'6 l 1?' MA Sen L4kidtaG Mfililrzg Address (Adjacent Property Owner Information) ,S7 77at77re he sl-e� L Print or Type Name 94,a,T Mailing, Address ADJACENT RIPARIAN PROPERTY OWNER STATEMENT C K _Q< I hereby certify that I own property adjacent to ( ame of Property Ow er) property located at (Address, tot, Blo k, Road, etc on a,� Crae in,�le>,J 9anm7eK 47 , N.C. (Waterbody) (City/Town and/or County) The applicant s described to me, as shown below, the development proposed at the above loc tion. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proosing development must fill in description below or attach a site drawing) 0 ono -caw , � F Ma3o� LA'�/Ji� /Ve ZyYl/ 8► I g3.ao T 6xi-4f .rl� S6' 00-e( To ra?1&4e_ r_ l 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. (Ifyouwish to waive the setback, you must initial the appropriate blank below.) /'1 I do wish to waive the 15' setback requirement. 1— I do not wish to waive the 15' setback requirement. (Property Owner Information) T+VL 0&-a (I D I (Adjac rit-Pr p tty Owner Information) S�atw•e Print or Tye� Na e ,�,� Mailina,Address