59208D - Tisdale

Street Address/ State Road/ Lot #(s)
II�
Subdivision
City TorsP r L- f AGt(— zIP
Phone # OtO 0--l-FiK River Basin
Adj. Wtr. Body �a i" I " C n MhJ6 /(nat
Closest Maj. Wtr. Body V MAIL S a utt>
(Scale: I I/
CAMA / DREDGE & FILL
GENERAL 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
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC `7 �Zm
;�.�❑ Rules attached.
'it Name OBI Ti srp, L,& Project Location: County LN PE <—
c I N CUaU� AIE .
I Statek!1C zIPz�
E (" !A) 620 —' '��UCJ� Fax # ( )
!ed Agent
Cw EW ; PTA ❑ ES --I PTS
OEA HHF _ IH ❑ UBA Cl N/A
Pws' ❑ FC:
yes /` no PNA yes Crit.Hab. yes tj�
lof Project/ Activity
dock) length
rm(s)
r pier(s)
length
number
ead/ Riprap length
avg distance offshore_
max distance offshore
channel
cubic yards
amp
ous atl'
Bulldozing
line Length
not sure yes

� �I , I 1 P -rn 14-e r)
DIVISION OF COASTAL 'MANAGEMENT
'ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAT] ONI4't'AIVER FORM
Name of individual applying for permit: (DO yA
Address of property: III McalutA G e
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_ rtith dimensions, should be provided with this
letter.)
I y � have no objections to this proposal.
If you have objections to what is being proposed, please Amte the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
obiection if you have been notified by Certified Mail
WAIVER SECTION
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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.)
14,I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
ignature
L
k Print Nam
x cI/? 7.3E -gaf-')-
Telephone number with area code

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAVAIVER FORM
Name of individual applying for permit: -Don I i s c41
Address of property:
I hereby certify that I Dwn 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, should be provided with this
letter.)
y I have no objections to this proposal.
if yuu have oi�jectioms to what is being proposed, please wnte the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or. call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
obiection if you have been notified by Certified Mail
WAIVER SECTION
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house. Iift or sandbags 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) I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
Signature hate
k CUUt,V1 rY0.Z4c'-y
Print Name
X 919 630 -aoo
Telephone number with area code

Letter of agent
I % e Nyl t d /c, -7 i s do l-,, f Y 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, LAMA, DWQ or any other state and or county ordinances.
Print name
Signature
d h s d-af t (--;' date AO-tl' 7-6, -2-'j' -Z
Contact information
33b-6So-b -14'7 Ccl
33b- 72,f 1"$ /
33E. -7b.i-- 7%26 C� )

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plicant: IS„I I (1 — Permit #:
«<JJJJ
ite: -f
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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)
Af
Dredge ❑ Fill ❑ Both ❑ Other
CV
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 ❑