63120D - Hawkins

I LAMA / ! . DREDGE & FILL Q �Aa
- 63
3ENERAL PERMIT �1
Previous permit # U
New Modification 'Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources Zoo
-oasial Resources Commission in an area of environmental concern pursuant to 15A NCAC N o
U r�I ,�....� �� `
❑ Rules attached.
t Name 1 I�W�>(-ii�
Project Location: County
�_
Street Address/ State Road/ Lot, (s)
C �iY�K4J _ StateN C . ZI P d' H
�U 114
(oZp # O
Subdivisio Q/ j
:ed Agent C1(,E/I2,T-:/V
City% 1? ZIP
CWW PTA ❑ ES ❑ PTS
'S%�
Phone # River Basin
❑ OEA /❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
❑ PWS: ❑ FC:
/ no PNA (ON no Crit.Hab. yes / no
Closest Maj. Wtr. Body�j��
' Project/ Activity
ck) length jp x
ier(s)
r-e i .*-u f,
ngth
iiiiiii■■■
nber
• distance =
iannel
■NINE■■■■■■
MINE
11EEM
■�
�■
)ic yards
1p
E1
,_1.90
ozing
■EE■iiMEN
�i:�'�r4
ENNE120l11
00E1I1
EMOMEM
- C'E■frct�t�lC�
1
n
(Scale: //L-
'�`-� r'J141a A
0
❑ See note on back regarding River Basin n
,—%A ,.-.

DBlicant: VC41i
ate: 1,6
_/ ,
A WONS
Permit #: 6 3 )-Zv
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
hitat Name DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
/W/
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 ❑ Other ❑

CLEMENTS MARINE CONSTRUCTION INC ® 3309
112 CIRCLE DRIVE 910-270-9110 86Jo/531
HAWSTEAD, NC 28443 365
Date
lis�✓rir� �� l Dollars 6
Back.
First Citizens
® Bank
For �� (03� ._
• F
..

Crepe.
ss'8k 0 *d
9
NL�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
i
Address of Property:
91rw h°i"/Al
(Lot or Street #, Street or Road, City & County) Agent's Name #: ,�`,—�� Mailing Address: /e—
Agent's phone #:
I hereby certify that 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 must be provided with this letter.
x I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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 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.)
I do wish to waive the 15' setback requirement.
Ix not wish to waive the 15' setback requirement.
(Prope Owner I rma 'on)
Signature ,
Print or Type Name
i/z Gl Yc ,l
Mailing Address
l _ A
(Adjacent Property
�pOwner Information)
/, &J� O
Signature
.011ie- 4e< e �ocA,11,
Print or Type amdf
.W 0/de
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: c/
- _ /,(Lot for Street #, Street or Road, City & County)
Agent's Name #:: �ZG :C_—_ ` ✓�w Mailing Address: ��L Gi•� �Y
Agent's phone #:
I hereby certify that 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 must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Informa 'on (Adj t Prope w I ormation)
ignature
Print or Type Name
//Z C�•-/�
Mail g Address
SkV>>2II 4 �L6AX,'Il
Print or Type Name
�30 006 �aiA-)�
Mailing Address

Letter of agent
I V F-F tJ wm� V,1.4& 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.
� CRtj �Lv V'Zrt s
Prime
Signature
N614rL . (336) 107 -013date I1- l6-13
Contact information