55844D - Crumpler

CAMA / *DREDGE & FILL
GENERAL PERMIT Previous permit #
New EModification ❑Complete Reissue El Partial Reissue Date previous permit issued
^ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
�� l i � Ru attached.
t Name { Project Location: County
P0. Street Address/ State Road/ Lot #(s) r
W1Iaa State c ZIP_ "A b-
O Fax # ( ) Subdivision
edAgent MAV 01Qn�Q� City ZIP
❑ CW Xi EW /f IPTA ❑ ES ❑ PTS Phone # ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ U13A ❑ N/A Adj. Wtr. Body nat
❑ PWS: ❑ FC: ' - i ,,f
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body Al W V\ "
f Project/ Activity
(Scale:
lock) length _
m(s) g� X ZO
pier(s)
length
lumber
i
!ad/ Riprap length —
vg distance offshore 1
nax distance offshore
channel
ubic yards
imp
)use/ BoatliftX13
f
Bulldozing _
ne Length
not sure yes no
gs: not s yes no
)rium: n/a es no
es
Attached: yes
f�
�Wp1�iF
ling permit may be required by::
1

Name of Individual Applying For Permit: - -
ley
6�2
Address of Property=_- --�-
(Lot or Street #, Street or Road)
(C- and County)
.11 ! tit • • llt 1' EMi !Y. 1 :sM� ! et L! !l
eas shown 4:1 the.[i.Y.; !mot drawing-thedevelopn
drawing,
• it • t.i :J.1 '!. .! should ` :.f be provided with U
am Proposing. A descliptiOn Or
is
Lhave no objections to this proposal_
If you have objections to what is being proposed, please: write the Division of
Managemen, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910,
whin 10 days of receipt of ibis notice. No response is considered the same as no ob.
you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, dock, mooring Pilings, breakwater, boat house or boat
lif
set bck a minimum distance of 15' from my area of riparian access - unless waived t
you wish to waive the setback, you must initial the -appropriate blank below.}
C I do wish to waive the 15' setback requirement_
I do not wish to waive the 15' setback requirement
Sign Name
,8eIT-1 L��i�
Print Name
-;(°
Date
X

,.-rr%-rrci('eTT(11
Name of Inditindual Applyi,,7 For Permit:
Address of PropPrtY=
C 1-le
(Lot or Street #, Street or Road)
� Gt t 16
e �e
(Ci and tountY)
I hereby certify that I own property jaCent to the-above-refanc ed-pmpeltY- The inc
s � wed to me as shown m the attached dr�*ingthe developm
applyingsing_ A option or drawing, with dimensions, should be provided with this I
are prop
ff`-� �Wk I.have no objections to this proposal.
If you have objections to what is being pro�, please Nwrite thecall Division 3
nW
Management, 127 Cardinal Drive Extensio, �
within 10 days of receipt of this notice. No response is considered the same as no obj
you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boat house or boat Uft
set bck a minimum distance of 15, from my area of riparian access - unless waived b;
you wish to waive the setback, you must initial the.appropriate blank below.)
I do wish to waive the 15' setback requirement
i do not wish to waive the 15' setback requirement
r z c
Sian IN-4 Dale
4nt!ELI�-EL�c
Ul
{ \ Print Nanae
MWA
=.�..:'_._.
urnpw

Letter of agent
r
1 I � '� f have retained Mark Clements DBA, Clements
Marie Constructi nc, tom a 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 1 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.
date iwa--
Contact information

i}

0

Division of Coastal Mgt. Habitat Impact Computer Sheet
'licant: Q ��,i r� �,11Y� Permit #:
W30,1! 0
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
,id in your Habitat code sheet.
iitat 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/o
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
l !,
U
Dredge ❑ Fill ❑ Both ❑ Other
(�
0
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 ❑

PT
CLEMENTS MARINE CONSTRUCTION INC 2076
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443 ss-3oi53t
7t � �j"� 365
(� (/ Date
P--atte� to
Urder
,„/m Dollars 8 5i"'°,
...,.,..
First Citizens
fiBr a U�zens.com
For -Li H
i:0 S 3 LDD 300':00 3 S 3 208 L 4 SBiI' 0 20 7 6
coasrnL views+
L H.n.e aaM.