63142D - Smith

�CAMA / '❑ DREDGE & FILL �( �'�� 4T.'
3rERAL PERMIT �, Previous permit #
ew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC '1 _
��r�� u es a ched
t Name
ri
VAO 444tate A/ C ZIP
( ��1 Fax # () .`}
ed Agent { // ,� ✓ f—�� C +�y0 j / 5
❑ CW kl(W 5i A ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes / 0
PNA yes / o
Project/ Activity
;k) length
!4'x/6,
er(s)
igth
nber
I/ Riprap length
distance offshore
x distance offshore
annel
iic yards
ip
s oat' 13 kl�
Length
Project Location: County / 4;51 /�
Street Address/ State Road/ Lot #(s) '2)S y
C G�hH� Aelye Illw Y
Subdivision
City ZIP
Phone # ( ) �+Riiver BasinJ�l/�i'
Adj. Wtr. Body S C. 4ts•t/ Ie / nat
Closest Maj. Wtr. Body C7,rICeo / /�-
(Scale:/
I
ttached:
ig permit may Be required by:
A
❑ See note on back regarding River Basin n

)plicant: b04,11;e
ate: , 2�5-11z-l
Permit #: I�3 / -1712
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
�itat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
�J J
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge Both ❑ Other ❑
Dredge ❑ Both ❑ Other ❑Dredge
❑ Both ❑ Other ❑Dredge
lFill
❑ 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
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443
Date
-2 A -0 j—
3347
6630/531
365
-Dollars 8 - °°
First Citizens ----
Bank
For
1Np
i•n r-:i inn :inni•nn a c a ann i l- r-nii• n :L :1 1- r�

Clements Marine Construction Inc,
112 Circle Dr.
Hampstead NC 28443
[e-mail]
910-270-9110 office 910-620-9505 cell
Good Morning Rob,
This is the permit application for Dan Smith at south channel drive. I will start this job
next, attached is the signed wavers along with his letter of agent consent form. I would
like to use the check for the North Channel pier you are currently holding for me and I
will pick that permit up when we move in to do the pier at his new home. Thanks for all
the help in this area. I did not mean to jump around like this but the one he wanted to start
first got switched on me. Thanks again!
Best Regards,

-ploI'N" � ,�CN
3 ° �W 7
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RECEIVED
DCM WILMINGTON, NC
JAN 15 2014

Letter of agent
Ibgj—)��b Il(� have retained Mark Clements DBA, Clements
Marine Construction Inc, to make dpplication 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.
Print'nari
W L � �/j
Signature
%t3-aOU- t5 date 1 3 Ict
Contact information

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. Q A M 5 M i �h
Address of Property: 20,5 1otVh Cyr\ano-P-A Di ny� 1n�nah�Sutl� (�
(Lot or Street #, Street or Road, City & County) Z
Agent's Name #:
Agent's phone #: ODO �ZO-9-PrC5
Mailing Address: ) 1 Z Gtr-Cje- OY-W<-
)46 MOsie?j- sic- ze+4{ 5
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. Contact information for DCM offices is
available at ifw.nccoastalmanagement.net/contact dcm.hr;: 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.)
do wish to waive the 15' setback requirement.
I do of wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Z&Z.,f e lewlel6,4:
Print or Type Name
//2 C/rcl
(Adjace
Signature
Print or Type Name
2©Cj S.
Ma 1 nir g Address
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. Q A M S M► �h
Address of Property: 205 �50LA: h e.1W101EI 1:;)nVC- V304hj5U1 - L
(Lot or Street #, Street or Road, City & County) Z1
Agent's Name #: PdP",-Y- rAeMerlf5
Agent's phone #: R) D b ZD
Mailing Address: I Z OrkVC.
oa►ups� yL zg,+�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.
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 nccoastaimanagement.neticontact 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.
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
w' ow ive 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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
Proper//rty'Owner Information)
PAW or Type Name
��- i�� �/
ailing Address

►j
o p PI
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r
Yll
DCM WILM NIGTON, NC
JAN 15 2014

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ) �/'�, t 1`k
P
Address of Property: 5.
VI)
(Lot or Street #, Street or Road, City & Comity) /
Agent's Name #: Clem �°� �j Mailing Address: _ ) 12 CI 24
Agent's phone #: -'I t 0 % %70 eY/% Q ge-, 2a�iy�
AM
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 nr000sed_ you mast nntify tho Mvicin„ of c^astai M2nzgomant
(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
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.
(Property Owner Inf9pnation
Signature
Print or Type Name
(Adjacent•Prope O r Information)
Signature
Print or Type Name
Mailing Address
0,6 j 5, 04A t fN&,-
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 12L) f:nn , I / k
Address of Property: 019,11 S. /med or,
(Lot or Street #, Street or Road, City & Cou ty)
Agent's Name #: sllmy c'e%r1en) Mailing Address: ) 17, CI rC k Pr,
Agent's phone #: e-1 10 Z 70 Z?/% 0 a� �40 G 2.6 el
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 oposing. 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. Contact information for DCM offices is
available at www.nccoastalmana_gement.nebcontact 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.
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.
(Property Owner Info ation
Signature
Print or Type Name ,
//A A, -//. /J9,
(Adisf nt P perty Owner Information)
�
Signature
Print or Type Name

-/ N° 6
lCAMA / ❑ DREDGE & FILL `
30NERAL PERMIT Previous permit #
Aew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCACE1110(7 —
y� A / a; aqached.
it Name Project Location: County Z dd�
Street Address/ State Road/ Lot #(s) 2
%� 1 ►��'�l� to N CZIP8
( V-fV5 Fax # ( ) Subdivision
zed Agent y✓ f—/�C 017 2'5 City t4✓e14b &✓lY1'? ZIP L
i ❑ Cw V16 [t A ❑ ES ❑ PTS Phone # ( ) ✓ RRiiv�er Basin x
❑ OEA ❑ HHF ElIH El USA ❑ WA Adj. WV. Body C '1G1hHL nat
❑ PWS: ❑FC:
yes / o� PNA yes /�o Crit.Haib. yes / j` Closest Maj. Wtr. Body ram~ /!
1 Project/ Activity
0
//iL
(Scale:/
�Tx_
! 1 I I 1
II `I
C _
n a- { - ? {
ength
umber + /err
ad/ Riprap length_—(_%��-
✓gdistance offshore/I j_�"^�
tit
tax distance offshore
j i I
:hannel { r � ! 15
Dtse! -_
Imp ✓ �I { I 1
ubic s I
r3)ry
Bulldo • -
-L]Oliff n'
no Length
not sure yes I {—
!
ts: not sure yes . �_ 1 - /It 7� l 1 I
xium: n/a yes no
Attached: esno
Basin R
see note on back Ner
ling permit may lye required by:—�/--/—`I' r) reprd,/

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