55872D - Hoffman

CAMA / IDREDGE & FILL
0
ENERAL PERMIT Previous permit #
I,,,leiv 'Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources �� ' /�
�
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC !/D/'
El Rules attached.
it Name _ p
j n_ Project Location: County
��
Street Address/ State Road/ Lot #(s)
State AC ZIP '�12- 15,4 ' A471/-1 LGye
Subdivision
:mod" ent ✓ L (riYl�rld'YJ ! Cityl/��/ �Larr� i ci�L ZIP
ElCW ElEW El PTA LCS ❑ PTS Phone # O, ��arr� River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body % �l nai'
r ', PWS: ❑FC:
// no PNA yes /® Crit.Hab. yes / no Closest Maj. Wtr. Body
(y s
f Project/ Activity
ock) length—�
-m(s)
pier(s)
length
G-
lumber
m / Riprap length j
wg distance offshore
nax distance offshore
channel
I
— P-
ubic yards t�
amp _
)use/ Boatlift _
Bulldozing
ne Length ti
f i-4
--
notsure yes o _
igs: not sure yes o
)rium: n/a yes o
yes o
Attached: yes n
ling permit may be required by: N «J
(Scale: %
❑ See note on back regarding River Basin

Letter of agent
I Catherine M. Hoffmann agent for Matthews Family Properties of Du lin LLC 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.
Catherine M. Hoffmann
Pri'M name
date
_Ej - -ID
Signature
P. O Box 871 Lexington, NC 27292
Catherine hoffmann@davidsoncounMc.p,ov
336.225.6779
Contact information

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to W , N a4\ 0 G, :5 Is
property located at
(Name of Property Owner)
(Lot, Block, Road, etc.)
Let S
on V0 , in 1)e� heal Ls_;�, 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 be filled in by individual proposing development)
p1��j0i� I � f 0�,�i
Signature
,�
, 1 �r
1 -)())I 'a Icy.
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L,'N r 6 6 r► k n (I 's
(Name of Property Owner)
property located at CQ 1 t-� 6A egg L
(Lot, Block, Road, etc.)
on �� 1 I �,Ptl Vle ►� , N.C.
(Waterbody) own aid/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 individual proposing development)
7
S gna re
\ Ll
Print or Type Name

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
applicant: �,7 �te�l�.� hL91K4-441h Permit #:`c"z:� 7Z
Date: QJ►/��/��
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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 fina
disturbance.
Excludes any
restoration and/(
temp impact
amount
Dredge ❑ Fill Both ❑ Other ❑
' , Zv
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 ❑

.we. tem ee.. wows
CLEMENTS MARINE CONSTRUCTION INC 2098
112 CIRCLE DRIVE 910-270-9110 66-30/31
HAMPSTEAD, NC 28443 9-5
io-/D
DaL,
A In I $ .200. 00
Dollars 8
�i First Citizens
� Bank
a o e rns.com s�qm
-
i:0 S 3 L00 300i.00 3 S 3 208 L4 S13"v 020913 GOPSTI
Hd1.m Clarke