62529D - Youngblood

'CAIRIA
✓ N: 62
/ , DREDGE & FILL
ENERAL PERMIT
Previous permit#
JNew [-]Modification -_ Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 57V/� �/,
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC `n v
//t Name .'JeuA114f
Rules attached.
Project Location: County
W.
Street Address/ State Road/ Lot #(s)
L.'1/r I Vv, "r9 tp'j State �� ZIP 1.-C"
It (qjt' ) Fax # ( ) ._.-----
Subdivision LernS�'`f�
zed Agent ''�l /' C.. �L�++�Gn �S
/!
City ZIP �+////G'''�'
d CW EW PTA _ ES PTS
Phone # ( ) `� River Basin
OEA HHF _ IH = UBA N/A
Adj. Wtr. Body li•t�l tef S
PWS: FC:
yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body 114.4 50ti
A Project/ Activity '1"N6fG` � / CT 1 ,
lock) length
pier(s) 1�
length
umber
ad/ Riprap length
- — �❑ t
vg distance offshore
iax distance offshore
:hannel
ubic yards
imp tir
>use oatlift Q (/
Bulldozing
ne Length
i
not sure yes
gs: not sure yes 5 Aer
>rium: n/a yes o
yes -
-- F
Attached: yes,' no i1 ' ,L
ling permit may be required by: /�17 c /© ='' �P/��S f
.. — ..-. 1`t /. _ A --Z/I rJ /
(Scale:
❑ See note on back regarding River Basin

)plicagt: �10 Yew b loOo�
ite: 7/05
Permit
scribe below the HABITAT disturbances for the aoolication. All values shnulri match the name. and units of measurement
and 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 FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill ❑ Both ❑ Other
�v
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 ❑

love Now
vom & UM
NSTRUCTION INC ® 3113
66.30/531
365
o,q
�A
/ —
DoFV.
llars 6 „V.
353208Ll4SlB"l 03L13
SC-;:�;_+^Y"`'Y:,:4i�'.2'#,:��ri!.. 'x;. -►71Y :$f?���•' w': `'- COASTAL VIEWS�

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ie purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
Jividuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
)astal Manasement confirmation that a written statement has been obtained signed by the adjacent riparian property owners
3icating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
intractor or other individuals acting as an authorized agent on behalf of the applicant.
his form was sent to you by the following individual or company designated by the applicant as an
uthorized agent: / �'
,uthorized ,Agent's Signature
Date
fame of Individual Applying For Permit: jo! i14
address of Propertv:,G 7' h/
(Lot or Street R, Street or Road)
C
(City and Co
hereby certify that I own property adjacent to the above -referenced property. The individual applying for this permit
ias described to me as shown on the attached drawing the development they are proposing. A description or drawing
vith dimensions. should be provided with this letter.
i R - I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management, 12'
Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
l understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
minimum distance of 13' from my area of riparian access - unless waived by me. (If you wish to waive th
setback, you must initial the appropriate blank below.)
0�-.- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. •
A&MMA
Z

Letter of agent
I ( have retained Mark Clements DBA, Clements
Marine Construc ' Inc, Wmake 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.
Y_ �ovn �jaod
P ' t name
JY71- 31�nwe y �/
date � `y /
Contact information
RECEIVED
Hann %nni nntNrTnN NC

Clements Marine Construction Inc,
112 Circle Dr.
Hampstead NC 28443
clementsmarinecogbel lsouth. net
910-270-9110 office 910-620-9505 cell
Dear property Owner,
Mr. Youngblood has retained us to install a fixed lower deck and a davit to pick up his
john boat and set it on his existing dock. The form that is included in this letter is
required by the NCDENR or CAMA permit process. I have also included a drawing of
the proposed work to be installed. If you have no objections to this proposed work please
sign the form and return it in the self addressed envelope I have included for your
convenience. Thank you for your help and time in this matter and if I can be of future
assistance to you, please feel free to contact me at 910-620-9505.
Best Regards
RECEIVED

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ie purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
dividuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
)astal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
dicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
r certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
intractor or other individuals acting as an authorized agent on behalf of the applicant.
his form was sent to you by the following individual or company designated by the applicant as an
uthorized agent:
Agent's Signature
Date
dame of Individual Applying For Permit: /1/%/L//AG�
address of Propem:iJ"9117N/-/I Sibs t7'e G f h/
(Lot or Street �, Street or Road)
(City and
hereby certify that I own property adjacent to the above -referenced propery+. The individual applying for this permi
tas described to me as shown on the attached drawing the development they are proposing. A description or drawing
vith dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management, 12'
Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
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, boat house or boat lift must be set back
minimum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive th
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 t� • : '

�'O,U ,K
,411p
N/A
V pvI r1G1 D �Opc