57329D - Wilson

CAMA / 'DREDGE & FILL
GENERAL PERMIT Previous permit #
fI,�w _-,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 15A NCAC2 /l /�d0
tLRI Rules attached.
nt Name /i�,a _
.4 State &,' ZIP % ?1,e-- -
# Fax # ( ) -
ized Agent
,d = CW EW PTA ,D-ES ] PTS
C OEA HHF IH ❑ UBA C N/A
C PWS: ❑FC:
yes / no PNA yes / no Crit.Hab. yes / no
of Project/ Activity
lock) length
•m(s)
pier(s)
length
pwl;ler
:ad/ Riprap length �b
vg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
ine Length
not sure yes no
igs: not sure
)rium: n/a
yes
yes
yes
yes
no
no
no
Rio
Project Location: County
Street Address/ State Road/ Lot #(s)
� Sdb Ts�.r•�r �� %1G�
Subdivision
City L t// �'z'���yy/�j ZIP Q-0
Phone # ( ) 1.+ ��/ River Basin �C
•tv
Adj. Wtr. Body /f/G, rf/dJ,-' �G��'/ , at
Closest Maj. Wtr.. Body �ijh�f/s !�'/'A-*'
f/) vZ
-,,e &lrtiA,"' 1
(Scale:
ling permit may be required by: AM 60- L15,aee ,5 6,eyt ❑ See note on back regarding River Basin
-- n._l,. '�I/ tin.).�A

Letter of agent
hoo „ On .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.
PAt name
Signature 11leiAq-6VZ2.-- (1date (2—(l
Contact information
RECEIVED
DCM WILMINGTON, NC
APR 2 8 2011
■ Complete itE„ns 1, 2, and 3. Also complete
iteM'4 if Restricted Delivery is desired.
■ Print your dame and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to
�� G���/. !ice„ ��. /�✓
A. Signature
X ❑Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is d ? s
If YES, enter delivery address below: ❑ No

�C�

p.1
RECEIVED
APR 2 8 2011
IDCM WILMINGTON, NC

p.2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Tea n L,a , � S o VA 's
(Name of Property Owner)
property located at 1 S Q<) 3fr-rie+ f ej , ( rn L n�,z del
(Lot, Block, Road, etc.)
on = C I i , in A)e ,^j H,,,a.,t r , N.C.
(Waterbody) (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 befilled in by individual proposing development)
r~ -
Signature

C Division of Coastal Mgt. Habitat Impact Computer Sheet
ilicant: 0(��kl d.�G /
l.✓i'Isoh,�� Permit
:e: ///2,0//1
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
oitat 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/oi
temp impact
amount)
Dredge ❑ Fill [9 Both ❑ Other ❑
-/ U
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 ❑

#49& wrolUN �rll'*Ia4 V.,Am TIMA ml*w
CLEMENTS MARINE CONSTRUCTION INC
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443
Date
Dolbys
First Citizens
Bank G/573aq�
or
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1:0 S 3 100 3001:00 3 S 3 208 lit Ar
am= 23SO
as Ali A wpm 6,
COASTAL VIEWS-
2350
66-30/531
365