57539D - Channel

CAMA / _ 1 bREDGE & FILL
GENERAL PERMIT
Previous permit #
LAeW 'Modifica(tion ❑Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in 15A NCAC
an area of environmental concern pursuant
to
J ` ILj
/�s+ulr /21e4#WOIH Rules attached.
Al
nt Name nPle �f%►�j r_ L40& IA Z
Project Location: County A k toz, "
s
Street Address/ State Road/ Lot #(s)
)7
StatekL ZIP
Fax #
Subdivision Ij! ,y
'zed Agent +' t_ t��'����5
J /
City �.(/j'y/�1Y/��� �P/il< ZIP --
Li CW ❑ EW L PTA ❑ ES ❑ PTS
Phone # River BasinDOEA �l
❑ HHF ElIH ElUBA ❑ WA
I
Adj. Wtr. Body (nat
❑ PWS: El FQ
yes / "�' PNA yes / jQ Crit.Hab. yes / no
Closest Maj. Wtr. Body Y/ -a
Of
dock) length
y l�
- pier(s)
length
lumber
ea�/ Riprap length
ivg distance offshore D'
nax distance offshore_
channel
:ubic yards
amp
ouse/ Boatlift
Bulldozing
..
ine Length >t5?10
not sure yes
ags: not sure yes
orium: n/a yes
s: yes) no
r Attached: yes -19
(Scale:/ /
ding permit may be required by: /' )4' �/f/%' f�j f f j// / , /���� See ten ba

Letter of agent
I C641ngj W0j kN6tjt rte "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.
DMOd-5; 2 R1Cte_JkA0L*N
Pri
r�;�,�.
Si ture
7110G19 - date q -$ -1
Con6ct ififormation
■ Complete items 1, 2, and 3. Also complete A. Si natu
item 4 if Restricted Delivery is desired. ❑ Agent
■ Print your name and address on the reverse ❑ Addressee
so that we can return the cans to you. B ceiVpcl by (Prided Name) LC4ate Delivery
■ Attach this card to the back of the mailpiece,V(�`J.vI1or on the front if space permits. Q ID. Is delivery addressdifferent from item s
1. Article Addressed to: If YES, enter del iveiy address below: ❑ No
3�- Ca�SPw Af
certified Mail . ❑Express Mail
red ❑ Return Receipt for Merchandise
OCT O
Mail ❑ C.O.D.`
4. Restricted Delivery?(Extra Fee) ❑ Yes
2. Article Number 7019 . 1060 0000 8472 5 016
(Transfer from service /aben
Dc r...,.. Q0i i

(1,1c �' I'14 i
ADJACENT RIPARIAN PROPERTY OWNER STATE-MEN7
1 hereby certify that I own property adjacent to unan(1e t " 6-firwNv�.
on
(Waterbody)
(Name of Property Owner)
(Lot, Block, Road, etc.)
in &a .t , N.C.
(Town 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(TO be filled in by urdfviduaI proposing devp*pmem)
ri
Al
rct�cur� �
7 6/ 7j�
r� Slgm e

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C Division of Coastal Mgt. Habitat Impact Computer Sheet
iplicant: dom, / W'Olk � �e ►`mot Permit #:
ite: '
scribe below the HABITAT disturbances for the application. All values should 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
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
46
Dredge ❑ RIX Both ❑ Other ❑
�UV
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El 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 0 Both ❑ Other 0

:CEMENTS MARINE CONSTRUCTION INC ® 2507
12 CIRCLE DRIVE 910-270-9110
LkWSTEAD, NC 28443
n 66-30/531
365
Date
to the
Dolkni o.•u. on
e.cw.
First Citizens
Bank
r C C I�%
:0 S 3 100 300i:00 3 S 3 20B l t. c;Ro n a i;n ,;