62603D - Gains

-CAK4A / ❑ DREDGE & FILL y
'ENVoclification
AL PERMIT Previous permit#
flew ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
'.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC12UG'
/ J Rules attached.
Name !� � 4 l f s Project Location: County /\ %e w
✓✓ PPPPG'�y+ Street Address/ State Road/ Lott (s)
i✓/ n, n A State Ne ZIP �✓�✓%Y f•
(i) 4U,�-95� Fax # () Subdivis)�io�n
edAgent r `yr lc Clet�of5 City !/ d"IlnjN ZIP
`�
VCCW L'riw 7"PiA ES ElPTS Phone # ( ) �'' River Basin L * -
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
❑ PWS: ❑FC:
yes / PNA f'e/ no Crit.Hab. yes / no
Closest Maj. Wtr. Body h
Project/ Activity _
:. length
.1
igth
nber
i/ Riprap length
distance offshore
x distance offshore
annel
Pic yards
1P 1
se/ Boatlift
Aldozing
Q _
Length
not sure yes
not sure yes
ium: n/a yes 9-.11,
yes no
lttach �d�'4 yes) no
ig permit may be required by:
s� >/ ly 6%'-W0 ,
(Scale: 1
V /
t❑ See note on back regarding River Basin n
-1 i1— . .1__
19

VF.,-,.
ate:
Hermit ?;: Or, D 3
: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)
L% Dredge ❑ Fill ❑ Both ❑ Other
g
3 Dredge ❑ Fill ❑ Both ❑ Other
7O
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
112 CIRCLE DRIVE 910-270-9110
HAWSTEAD, NC 28443
0 W.
66-30/531
365
Dat
� Imo-^
Dollars 8
First Citizens
Bank �' r
For `/t�T -..__. _ ... ... ...
—
1:0 5 3 L00 3001:00 3 5 3 208 14 58I'' 03169
V-Sa MWA qr
—1-d Clarke COASTAL VIEWS"

13 2013 8:01PM Dr. Michael Goins 910.392.0271 P.
Letter of agent
I _Michael GOINS 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.
MICHAEL GOINS
Print nameAMC%)
Signature date t3
�l/ D / 7 �J /3
Contact information

15 2013 6:24PM Dr. Michael Goins 910.392.0271
P-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERImOORING PILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ' VL t'jk'e' � 60"'.J s 's
f Prope ner)
property located at
S
"Bloc Road, etc.)
on , in
N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no obj ections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (IY) from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I/ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Print or Tvne Name

15 2013 6:24PM Dr. Michael Gains 910.392.0271 P.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIF)�T/BOATHOUSE)C<Do
I herebycertify that I own property adjacent to V" ,' 44'e � /�
fY
me of P erAy Owner)
property located at
Bloc oad, etc.)
on , in l , N.C.
(Waterbody) ('sown and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatli8/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
!-""' I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
y>��I,yry
GG�
Sc�l �ZZS

)ess o S C� h le✓ / �i1 ` �1Gf ' S/treet Address/ State Road/ Lot #(s) Q1V &�
-- � rh InrJ M _ _ _ _ state A � ZIP 70
ie # ('I.V)__i&�Fax # O_ Subdivision
iorized Agent r VIr City ZIP _2 0 IX?
=ted
^!CW -WW VTA LES PTS Phone # (_ - ). —��_ River Basin
s OOEA L HHF IH 1 UBA I N/A Adj. Wtr. Body _. K/�
( ): man
r7 PWS: I Fc:
es� Closest Maj. Wtr. Body _ ti
V: yes / PNA / no Crit.Hab. yes ! no
e of Project/ Activity Ce"51�7^�rC r//>
(Scale: .J�©
t- (dock length
ger pier(s)
oin length _
number__.--------- ---
Ikhead/ Riprap length
avg distance offshore__
max distance offshore
sin, channel
cubicyards
at ramp
athouse/ Boadift
ach Bulldozing
t
,her
oreline Length-
kv: not sure yes no
ndbags: not sure yes
no
oratorium: n/a yes
o
lotos: yes
no
'giver Attach*4 U
no
building permit may be required
by:
otes/ Special Conditions
hot
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V
f
u
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i
v
A Q) l h S
c (�9 7%f - I�OD
�n�rApph nt Printed Name
is re P ase read compliance statement on back of permit
Acation Fee(s) Check #
It I i
r �S✓lt�,vh
0
Y
t/
- ^— Ji' i— -- - --
e' See
~note
on back regarding River Basin rules
Issuing Date ' Expiration Date
5
Local Planningju diction Rover File Name