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14
CAMA / I i DREDGE & FILL �`_ G '��
3ENERAL PERMIT J�
-New ❑ Modification ❑Complete Reissue ❑ Partial Reissue
W 69
Previous permit # ?—
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmerptal concern pursuant to,l5A NCAC (:% /x/
. r les 4�T hed.
t Name !CS C� ` } I County�1'l�LiO1�P
¢2 99 ^-�-� �" ' Project Location:
Wt i K ►'� 1 Kam' G. �j Street Address/ StatelRo`ad/ Lot #(s)
�l h'1i f g �State ZIP Z 8 0 Z2 2 3 •( IC�G���' 1� +"
( A -:?W// Fax # ( ) ' " Subdivision
:ed Agent /*syrA l''/ S City 1 h ZIP �y
L+1CW F W ETA !`S [APTS Phone # 4'1/n 2P> River Basin %�'
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
IeN
ye / no
Project/ Activity
Length
not sure yes
not sure yes
ium: n/a yes
yes 1�
kttached: yes
❑ FC:
Adj. Wtr. Body %G'�1��� att
Closest Maj. Wtr. Body .�4 n:r�
ig permit maybe required by: //// r,YL,/L�i1 rG��/ ❑ See note on back regarding River Basin r

Gerke
Bank
38261 $1,200.00
GP 64639D
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ADC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: Vaal palwo %
Date:
�'/I Z A
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Pound in your Habitat code sheet.
-labitat Nam
/
5(�G��
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated Tina
disturbance.
Excludes any
restoration an(M
temp impact
amount
',,
III r
Dredge El Fill ❑ Both El Other
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Dredge ❑ Fill ❑ Both ❑ Other)
�70
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 ❑
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
khave retained Mark Clements DBA, Clements
Marine Construction Inc, to make pplication 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.
- �� AQ( A � �_X- I (�-
Prin nan
Signathue
ClLk:� - I-D OC - aA51A -- - _ date A3 V 5-
Contact information

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4-
11, 12, and a Portion of Lot 13 --- neE�„raow.:
e 6 metto Bluffs Subdivision — �W I T N I
oundary Survey
with Adjacent Lands

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P) e- IL -�,
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTI' OWNER NOTIFICAT] ON(ii'AIiTR FORM
Name of individual
Address of properly:
applving for pennit:_jq&tPr �- t
le <S,
C ?-qC/,
I hereby certify that I own properl 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 thi
letter.) s
I have no objections to this proposal.
If you have objections to what is being proposed please write the Division of Coastal
M <=ement, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mall.
WAIVER SEC'IJON
(Dees not appll- to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access uriless waived by me. (If you
wish to waive the setback, you trust initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
!/ I do not wish to waive the 15' setback requirement.
Signat re Datc
Print Nam:
?1'30V7%
Telephone nuinher with area code

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTYOWNER NOTIFICATIONMAI«R FORM
Name of individual applying for pennit
Address of property:
I hereby certify that 1 own property adiacent 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 descripti
letter.) on or drawing_ with dimensions, should be provided with this
I.,�have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 29405 or. call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mall.
WAIVER SECTION
(Does not appl}• to buiitheads or rip rap)
1 understand that a pier, dock, mooring pilings, breakwater, boat house, 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.)
I do wish to waive the 15' setback requirement
[%4y do not wish to waive the 15' setback requirement.
kign ure
Print Name G
9/0 6d'6 , f-�Pz d
Telephone number with area code

6Ao
DINqSION OF COASTAL N'IANAGEN7ENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAINTR FORM
Name of individual applying for pennit: c�
Address ofpropem-: ZZ2.3 M, JQIe- 6,,O i CQCP
i�j I6�11
1IV,
I,- r—Lo
/116,. 215Y
I hereby certify that I own property adjacent to the above -referenced propert} . 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.)
L,la I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or. call (910)
395-3900 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
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, break -water, boat houselift or sandbags must be
set back a minimum distance of 15' from my area of riparianaccess uWe'ss waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
igriature I )ate
Print
7 elepbone number with area code

130KhecA-8
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAINTR FORM
Name of individual applying for permit:,
Address of property ZZ23 Nit J 81GLOC'`t) �d 1,) i I rin tYl4 tar 1 /vC Z 5Y,
I hereby certify that 1 .ox-ni properh• 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 objections to what is being proposed, please write the Division of Coastal
Management- 127 Cardinal Drive Extension, Wilmjngton, North Carolina, 28405 or call (910)
395-3900 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
(Does not apply to bulkheads or iip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, 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 belo«•.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback: requirement.
Signa re 1)�u,
Print Name /
4'/0 763- OV7 f
Telephone number with area code