61533D - Smith

ClsMA / DREDGE & FILL
M G
EI JERAL 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 �1
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC r7 i Z�li�
t Name 1"o / T
29 Rules attached.
Project Location: County
J
` � C I l? !� (�/ r Lein+
Street Address/ State Road/ Lot #(s)
✓I ����l�U�`I State_je- ZIP /1
A— f
Fax # ( )
Subdivision !/ �f yJ�l�'�i %
zed Agent ��/ k i� ��°�(!�-r�
City Yyme, ZIP_
CW EW PTA L ES PTS
Phone # ( ) "� River Bassin
OEA HHF C IH UBA N/A
`
Adj. Wtr. Body Jr C
PWS: FC:
yes / no PNA no Crit.Hab. yes / no
Closest Maj. Wtr. Body
A Project/ Activity
JL'"`
ock) length / X
m(El i LwI/'/' �% X
4- ,',i -
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(Scale: /
ling permit may be required by: '�I jl7/ �d •N�j�rl�//�7 S f%� �. ❑ See note on back regarding River Basin

Letter of agent
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.
date
Contact information
A'S-Sts�-Unt : Wturn, Tadcn
G � u -�cv- U'1 U-1
dCM VVILI NtiGTON,, NC
FEB 1 1 2013

�j� I-T ��C-L r y�6
a

C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: 0- , S''", ' Permit #: 6 15 33
ite: / t Z f 13 I
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.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
bitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
Dredge ❑ Fill ❑ Both ❑ Other
l 2
�Z'j
O
Dredge ❑ Fill ❑ Both ❑ Other
©�
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
A. signature
X
❑Agent
❑ Addressee
B. eceiv by (Printed Name)
C. p e o Delivery
�r
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1 Yes
♦ /. V enter delivery address below: Cl No
�I fN, NG
1. Article Addressed to: �C
I t 61 n H LA t Lk (r in p�M �UltJll
erOOW117 dS /�-FEB 1
2013
f-' Certified Mail ❑ Express Mail
G �O
O
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number 7007 1490 0001 8396 4340
(Transfer from service labeq - - -
PS Form 3811, February 2004 Domestic Return Receipt
I
United States Postal Service® el
4 1.
I
Date
�� '/
Sorry We Missed Youl We Deliver for You
Z
L Item is at:
Available for Pick-up Attar
— Post OtficeTM (See back)
E —
Date:
Tine:
Letter
For Delivery: (Enter total number of items
if chedom
at urn
Large
delivered by service type.)
Artlde
_
envelope,
i ne'
For Notice Left: (Check applicable item)
catalog, etc.
_ Tss WHO _ Insured Mail
D�mul
\ �"�
102595-02-M-1540
5
or your agent must be present
Iry to sign for Item.