53916D - Brewer

'CAMA / DREDGE & FILL
GENERAL, PERMIT Previous permit#
L4New 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 I SA NCAC 7
C.3Rules attached.
nt Name Project Location: County 0?"ors
s U12 Street Address/ State Road/ Lot #(s)
State ZIP �' j L l 1 Y� L L_L Ott .
rize(
) J'IL-t - Fax#( )_
d Agent ('Y) &1e !L C L_ LYY-k Ic S
�d CW C}EW 'PTA GEES E PTS
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
1�
❑ PWS: ❑FQ
Subdivision 6ir-y C S
City1XT kD"D ZIP_
Phone # ( ) River Basin %
Adj. Wtr. Body L- -!- L i at
m-r
yes / � PNA yes /�j Crit.Hab. yes / no Closest Maj. Wtr. Body
of Project/ Activity i L J� 7 i nV L K rf i rJ /1,1 &7-- f-V)
(Scale: 1 _
Jock) length
rm(s)
pier(s)
length
camber
:ad/ Riprap
rvg distance
nax distancf
channel
:ubic yards_
amp
ause/ Boatlil
Bulldozing_
ine Length _
not sui
igs: not sw
:)rium: n
Attached:
ling permit may be required by: 19CIO ❑ See note on back regarding River Basin
/ Snnrial Cnnrlitinnc /-I L t- r RAJ,-) I -n PA (' A J -7 iJ 1 1 /+7 V 5

Wision of Coastal Mgt. Habitat impact Computer Sheet
ant: Permit #:
'N(�PJ10
be below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
�t Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tem impacts)
(AnticipaApplied
disturbisturbance
FINAL 7atonan
Excludtal
restoy
and/ostoration
impact amount)
OTAL Feet
for.
includes
anticipated
or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill Both ❑ Other El
50
Dredge ❑ Fill Both ❑ O7theDredge
❑ Fill ❑ Both ❑ ODredge
❑ Fill ❑ Both ❑ ODredge
❑ Fill ❑ Both ❑
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 ❑

Letter of agent
I e- cp-",j have retained Mark Clements DBA, Clements
Marine ronstruction 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.
(A 'V'1 -, e --o --�
Print
Signature
3 2 0.5 date -3
Contact information

-2010 10:02 FROM:CAPE FEAR MARINE YAC 910-256-6386 T0:2709110
b lu uZ1:9ia marK l.lemenLs zJIU-e1U-ZJ11U
Mae of Individuai Applym�
For Permit:
in
Address of Prop rty: `� r
(Lot or Steer #, Street or Road) n
(City and
P.1/1
P• l
z b=by
that I own propatY adjacent to the =19. 11r. incUMi
applying fcw this pemitbffi dew ed to me as shOwr L am the wed &-"nn.g thedevrlopmentl
this lend
are p er. A det x�i g aV drawing, with d'MCVS'0W. should be VMvided with
rn �
I have no objections to tius PrOPOSaL
If you have objections to What is being proposed, pleaseNwrit C 28405 or call 910-395-vision of g
Mauagemerrt, 127 Cardinal Drive Extension,�Q�
within 10 days of receipt of this nOtim No response is considered the same as no objecfi'
you have been notified by Certified MaiL
[O
I understand tLatt a pier, dock, mooring pilings, breakwater, boat house or bout Lift ma
set bck $ minimmm dtst2nce of 15, from my area of riparian access - unless waived by me
you wish to waive the setbark, You must initial tile.appropriate blank below-)
I du wish to waive the 15' setback requirement.
Io not wish to waive the 15' setback requirement '~
f`
Print Nmuc
y �lU-ofl ^
M-
�=ENR
. a.o..•• ow,....a. 1W

MO VK1
ver

CLEMENTS MARINE CONSTRUCTION INC 1909
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 29443 66-30/531
p 365
Date
is Apo
Dollars
First Citizens
Bank
firstcitizens.com 6p559 I(- fij
For
i:0S3100300i:003S320814Sl31'm 01909
COASTAL V