59173D - Gill

❑I CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
—'New ❑Modification ❑Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
.r# / � l / / ( Rules attached.
nt Name :Ie4h G' Project Location: County / e 41.,
s 33Z /--/ 4�r 4, Street Address/ State Road/ Lot #(s)
State ' ZIP` /C// Slil
# (910) Qb--95t! _ Fax # ( ) -- Subdivision
zed Agent 4,e,,40i,"e �� 7�s City _ ( ZIP /Sl
❑ CW LAW i r? PTA ❑ ES PTS Phone # ;River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA N/A
❑ PWS: ❑ FC: Adj. Wtr. Body 411e 611e n
yes / no PNA yes / (9 Crit.Hab. yes / no
Closest Maj. Wtr. Body 1*1e1 ' 1 5'rl,%,
g■_ol'wMm�w�ii���ii
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❑ See note on back regarding River Basin

Letter of agent
I John Gills 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.
Print
Si - 69(. 44316 date 3 —4 - I Z.
Contact information

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-06-2012 16:24 From-GREENVILLE TOYOTA
P00 and VlOhOL 111AN ED-%
252:211324
7-402
P.002/002
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Marne of lvcTvidmi apylyft for purnic Mr . John G i 11
Addmwdfpra@atoy: 83 2 B 1d Bartle Ln_Wilairistton Nc 2843.1
I bmtebf agfiiy tbmt I om plow 0 t to the abow4d"Momd PmVaty- rw in ivibdcal
applyin for ft part he gibed to me as *m m on the arisdW the
*ey W Apt (A ameriptiom or with dams, sboaid be pmvided Zvidt � dui
]ettrr_ j
i
I ! me ckloc6afts to this pwoposo L j
If yca bo dDjecdam m wha is being proposed, p1mm verice fe Divisiom of
ManmVzoest, n7 Caul Drive dos, WduumStm; North Cambia; 2MW or o1 (�M)
395-am vriebda 10 4bms OrTweipt of ffiis noun v is co *
4b5.es�oo ifvr sae bs+ea�ed�r� by CertTlftd Iv1sr�. _
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WARE$SEGTION
pats motsp*w ork* rap)
j tibot i pion dads, nww ing pdi*x. baeahwatrr, bast btiusc, Ta Or s
$ of l� �a� my aea. a�rip�iaoa �a smd4sa br mc.
wish the selbncb. yva ma "�i6 �P'�'aO b� bdovr_)
do w1ob10 waivc*-' 15' xc+quisc�
IRgs Wbh so vraivc tle 15' regsirenwL
be

07: tQ12 WED 12: 46 PAX
FAX NO. :9106H64316
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Mar. 07 2012 12:54PM P2
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Name of individual applying for r errnit: %x . j ohn G i 11
Addrmofprop y 83 2 dal_ E �Ie Ln.WilminAton NC 28411
I hereof certify that 1 pv►-n property atidjtocat to the above^re ammccd property. The individual
applying 1br tbb permit has described to mo w shvwn on tiu PAUohed drawing the dmrlopmant
they am proposing (A dm=iptiou or drawing, with dimeasioava should 'bo piovlded with ties
]otter.)
i have no objections to this pr omd.
:f you iavc objocd= to what is Wing propoeod, please writo the Division of Cosadai
Mamgema , 127 Ciardival Diiva P.=nmion, Wilmington, Not't# CaroRm, ZM5 or -ail (910)
395,nO D wlthiA 10 dayr of receipt of this mfim % is cbn�derod the -sine as no
)R, RSP.=ON
(Deem eat Appt}' to balkbea4s or Hp rap)
7 nnderstand ibalapie4 dock, utooring giimp, breakwatit, boat bause� hfi or sandbagr trout be
rut back a nthti fro d%m= of 15' frown nny am of r*m im eaoe m s unless vraived by me- M You
wish to waive the sedsak, you t izr I the upprvpziaie blank below.)
do wish Io waive the 15' wd=k "gttitanmt
1 gQ.W w}eh to %Vino tht 15' setback nquirement.
rs ��
Print Nrane
3-1L S8?
Telephom number with ttrca

4icant:
e: v
Permit #: S-q / ?--3
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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
impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
_.temp
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 ❑