64621D - Medlin

CAMA / ❑ DREDGE & FILL 64
3ENERAL PERMIT Previous permit#
,'New —Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources ft
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ` ,i R c �" • ICJ
j C [IRu attached.
t Name l.11)'10 t .f Fk \ 1`NQ Ut i Project Location: County 17 (SIC
Street Address/ State Road/ Ljot�#(s)
f W P5�.�i State NyzlP G � L� -r �; jot t - 1V 4 n
r"
(pit— Fax # ( Subdivisi n
:ed Agent VVIA)Ly (J_. t: ATR - W(C, City }��(. ��� ZIP
CW L1EW ❑ PTA ES E PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes, no PNA yes / no) Crit.Hab. yes /
' Project/ Activity
ck)length Il
n bel`
i/ Rip
dicta
x disc
cannel
se/ Boatlift
Aldozi g
Length , /— �C
not sure
yes
notsure
yes
um: n/a
yes
yes
,ttached:
yes
ig permit may be re(
Phone # ( `--j-- River Basin C f
Adj. Wtr. Body /fi I V`, R/ (natA
4
Closest Maj. Wtr. Body 77p I( `�''' U t'jp
(Scale:' I f
_4

5/7/2015
5/8/15
Allied Marine Contractors, LLC
Henry Von Murray III
B of A
7366
$600.00
GP 64618D
_
Andrew Bray
GP 64619D
Mary Ann Tally
GP 64620D
5/1/2015
5/8/15 Land Management Group, Inc
Orton Plantation holdings, Allen's Creek Bridges -
First Bank
45408
$250.00
major fee. B
5/6/2015
6/8/15 Eastern Builders Inc - -
—--
_
Thompson
First Citizens Bank
3322
$100.00
minor fee, N
5/6/2015
5/1/2015
5/7/2015
5/8/15 Eastern Builders Inc
Bald Head Island Ltd.
5/11/15 Don B. or Connie C. Jordan
- --
Thompson
same
same
— -
First Citizens Bank
First Citizens Bank
NC State Employees' Credit Union
- ----
3323
1511
2806
-
$100.00
$100.00
$200.00
--
minor fee, N
mod fee, 19
GP for Jord<
5/8/2015
5/11/15
Wayne Smith & Son, Inc
Joe Smith
BB &T
19291
$400.00
GP 65138D
5/8/2015
5/11/15
Ricky Hewett construction
Ruth Netherton & Vicki Jesse
BB &T
4488
$200.00
GP 64603D
5/8/2015
5/11/15
Ricky Hewett construction
Reaves, Corbett & Rowell
Branch Banking and Trust Co
4629
$400.00
GP 64604D
5/8/2015
5/1/15
Backwater Marine Construction Inc
Jim Tobin
BB &T
1911
$200.00
GP 64607D
5/8/2015
5/11/15
Steven T. Farmer, Robin G. Fanner
Eric &Christi McComb
BB &T
7151
$400.00
GP 64605D
5/11/2015
5/11/15
Thornton Builders & Investments LLC
Thornton Builders & Investments LLC
Harriett Howe
BB &T
1895
$200.00
GP 64606D
minor fees, ;
_
Lot 11 & 12 Peninsulas
5/11/2015
5/11/15
Lot 15 Peninsulas
BB &T
1922
$100.00
minor fee, S
5/11/2015
AWA Buildiers, Inc
Allan Funk
TO Bank
7198
$100.00
minor fee, N
5/11/2015
NCWRC
same
electronic trensferfrnvoice
576
$100.00
renewal fee,
5/12/2015
Coastal Land Design, PLLC
_
Bald Head Island, Palmetto Bridge
B of A
5054
$400.00
major fee, B
5/1312015
Jeanne L. or James S. Wallis
Eagle's Watch HOA
PNC Bank
3859
$100.00
renewal fee,
5/13/2015
Robin G Smith
same
First Citizens Bank
6653
$400.00
NOV 15-07C
5/13/2015
JVCC, Inc.
190 Yacht Watch, Holden Beach
BB &T
3386
$600.00
GP 64625D
5/14/2015
Bayan Construction Inc
Lynn & Michael Seel
B of A
7040
$100.00
minor fee, 31
5/13/2015
Clements Marine Construction Inc
Dorothy Medlin
First Citizens Bank
3798
$200.00
GP 64621D
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--

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: t)D✓0
{ Cl ��1(� Permit #: (Pq 6 z 1
t/1�L
Date: S— 13 i S
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
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 fina
disturbance.
Excludes any
restoration and/
temp impact
amount
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 ❑
Dredge ❑ Fill ❑ Both Q Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Letter of agent
I 0 'T mcj I I ,n 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.
Darn4A a roll / n
PrRvarne
Signature
O -;7-0 -- date
Contact information

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Pl[VISION OF COASTAL MANAGENIENT
ADJACENT RIPARIANPROPERTi' OWNER NOTIFICATJONA6'AT\-ER FORM
Dame of individual applying for permit: ZM e� iIt 1 % L ` „� Oble )-Io - 1 x
Addressofpropertm•:Q�©q �Pj¢s Cn, �ivt40S.ad /lIC_
I hereby cerijfi- that I 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 description or drawing. with dimensions, should be provided with this
letter)
ce 41 have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Managernent, 127 Cardinal Drive Fa.-wasion,'t'jhningtou, North Carolina, 28405 or call (910)
395-3900 within 10 logs of receipt ofthis notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
WAIVER SF.CI'ION
(Does nvtapply to bulkheads or rip rep)
I understand that a pier, dock, rnooriug pilings, breakwater, boat Louse, lift or sandbags must be
set bark a minimum distance of 15 from eery area of riparian access unless waived by me. (if you
wish to waive Lbe setback you must initial the appropriate blank below.)
I do wish to waive the 15' setback Tequircment
x I do not wish to waive the 15' rtbad: requ ircment.
t
A , AOAJ�V-) 'f-- a 3- aC-) 1 s
Signatu ITue
i ! -Z arb e4 I) Ci w i
Print Name
Telcphone number with area code

DIVISION OF COASTAL MANAC1 M,. N`T
ADJACENT RIPARIAN PROPERTY 91NNER NOTIFICATIONA N'M1 TR FORM
Name of individual applying for permit' 12
Address of propeM!.A d!? / / s 67. ` s/he A A;C— -
I hereby certify that I Dwn propertv adjacent to die above -referenced property- The individual
applying for this permit has described to me as shown on the attached drawing the devOopment
they are proposing. (A description or drawing, oath dimensions, should be provided with this
letter.)
have tjo 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 "• sponse is considered _the same as no
obieetion if you have been notified by Certified Mail.
WAIVER 91,CTION
(Does not $pply to hulkheads or rip rake)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags trust be
set back a minimum distance of 15' from my area of riparmn acres!, 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
W4A do not wish to vvaive the lfi' setbael: requirement.
ignatt, 7»
�DELO 0 If LtJE r R is
Print Nang
-74
Tel phone number with area code