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Letter of agent
I r- L 42j6o a 9 IeA5 lfA, 5A 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.
C L.A/t
Print name
Signature
2.4 2_, 3 2S4o 7G 2 -122 S date 2 I.
Contact information

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to GIArEjoc-r-- 11e>rr is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on in , N.C.
(Waterbody) (Town and/or Coun )
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 individual proposing development)
I DO wish to wave the 15 foot setback.
---- I DO NOT wish to wave the 15 foot setback.
-4"
Y Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to C,Ia(-e()C_E- f1Efr 's
property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
on - �-V. , in , N.C.
(Waterbody) (Town and/or Coun )
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
AM/, (To be filled in by individual proposing development)
I DO wish to wave the 15 foot setback.
---- I DO NOT wish to wave the 15 foot setback.
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Signature
A5,4KI 6�7�4�1
R [
k Print or Type Name

ID Division of Coastal Nigt, Habitat Impact Computer Sleet
)plicant (a>�c� - Permit #:
ate:
�� lI
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Lind 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)
Dredge ❑
Fill ❑
Both ❑
Other
l p
I D
Dredge ❑
Fill ❑
Both ❑
Other
l d
D
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 ❑
Nh k in t (J V

rl,r ft! ew;;G 9W W" �' ?,{f' ' .,*,W'? V
CLEMENTS MARINE CONSTRUCTION INC
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443
Pa� to the
Ner of,
First Citizens
Bank
For "1 -T �(
1:0S3 L 03001:003S3 208 14S8u'
how
H,d,.,e Clue
® 2386
66-3031
365
Date
► $ 2-ev -
DoLys 6
0 2386
COASTAL VIEWS-