63245D - Smith

CAMA / ❑ DREDGE & FILL �` ` �� ` -- 6
IEN ERAL PERMIT Previous permit #
New !Modification LIComplete Reissue El Partial Reissue Date previous permit issued
"ized by the State of North Carolina, Department of Environment and Natural Resources /�
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0 -4 H • 17-oo
lorRulas attached.

Date Received
Check From (Name)
Name of Permit Holder
Check Number
Check amount
Permit Number/Comment:
5/2/14
Wells Brothers
lCapel and Bratton
45200
$800.00
GP 63249D, 63250D
4/29/14
Coastal NC Real Estate LLC
2033
$100.00
103-08 mod
5/5/14
Clements Marine
Dan Smith
3421
$200.00
63245D
4/25/14
F & S Marine
Hargrove
3711
$800.00
63263, 63264
4/17/14
Boatzriaht Inc
harris
1717
$200.00
63227D

IC Division of Coastal Mgt.
5plicant: b9zt,
�tl
ate:
Habitat Impact Computer Sheet
Permit #: � 3 y
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
and in your Habitat code sheet.
abitat 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 fir
disturbance.
Excludes any
restoration an(
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other/11
'OV
Dredge ❑ Fill ❑ Both ❑ Other
Z a J 4
20 J CO
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
ala t have 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.
r
Prin nan
Signature
%.t� -Q Gv- aA5v1 date 13 t(t
Contact information

' 6AZeL C
6i
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DAN 5m

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner.
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 41W ClezWeI Mailing Address: 'Irz� le 1-201m-P
Agent's phone #: ql%% AZo !F � !M
hereby certify that I own -property adjacent to the abovereferencedproperty. 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. Contact information for DCM offices is
available at www.nccoastalmanagement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
1 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 5' setback requirement.
I do not wish to wa 15' setback requirement.
(Property Ownerjnforrr*tion)
Signature
iV 9 LCIy% ids
Print or Type Name
(Adjacent Property Owner Information)
Signature
A l 2r713Z 1 /V i3 ,CJ ivI C /z00%
Print or Type Name
AAflilinn driflmcc
,3.2, D b 511l) o l-1 R (7
AAaitinn dririmcc

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner.
Address of Property: p_2y ZW.- '/G .7pv12a GaV,L je'of ZVZ&22i,a3=Z //c_
(Lot or Street #, Street or Road City & County)
Agent's Name CA�twm.& Mailing Address:
Agent's phone #: ZO C1,1a7c-Z%L�/-3
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. Contact information for DCM offices is
available at:rww.nccoastafmanapement.net/contact dcm.htn? or by calling 1-888-4RCOAST. 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.
x IkZV, . I do not wish to waive the 15' setback requirement.
(Property OwnerjnforrTWtion)
Signature
Print or Type Name
zzg
(Adjacent Property Owner Information)
gna re
Print or Type