56544D - Horne

CAMA / DREDGE & FILL
3ENERAL PERMIT
INevv -Modification ❑Complete Reissue
❑ Partial Reissue
Previous permit # [�L000
Date previous permit issued Z—L
rized 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 H . 1 � 0
p Rules attached.
it Name ;'i �'15U}! f'✓ a ;; Project Location: County.1412- 2 Ul V
Street Address/ State Road/ Lot #(s) L,0+s {p
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Fax # ( ) Subdivision
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yes no PNA yes no / Crit.Hab. yes / no
F Project/ Activity
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ng permit may be required by: G C� / aill ILK h. ❑ See note on back regarding River Basin n
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Letter of agent
I 6hrislWcr XY*J �0)01E 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.
07 rrs LaP/Y& 4fxf
Print name
Signature
date 8 12, 0
Contact information

HORNE, CHRISTOPHER (c/o: M. Clements) (PE)
Lots 6&7 Washington Acres Rd., Hampstead, NC
-SNIDER
■ Complete items 1, 2, and 3. Also complete
A. Signature
item 4 if Restricted Delivery is desired.
X 7 ❑ Agent
■ Print your name and address on the reverse
�'V ❑ Addressee
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
B. Received by (Printed Name)
C. Date of Delivery
or on the front if space permits.
1. Article Addressed to:
e Cal�cl �a��¢� y
2. Article Number
(Transfer from service label)
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Xt�ii:IVLL.
SRP
h
3. Service Type
EYCertified Mall ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7010 1060 0000 8472 2541
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

ch,6 S�vvluz tr�ll vu c NO
rm<!, &WAM T WNW, WWA
CLEMENTS MARINE CONSTRUCTION INC 2118
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443 66-30/531
— 5-0 Date 365
EIRWO mme"
COASTAL VIEWS-

Division of Coastal Mgt. Habitat Impact Computer Sheet
)licant: CAW►S il�N Permit #: CIP -5 5
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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)
' ' 1
�1
Dredge ❑ Fill ❑ Both ❑ Otherx
Dredge Fill ❑ Both ❑ Other ❑
'31
Dredge Fill [I Both ❑ Other El
G
Dredge ❑ Fill Both ❑ Other ❑
*Zi5 V V
-ZS6-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 ❑

CLEMENTS MARINE CONSTRUCTION INC
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443 2152
r Bank
firstcitizens.com
' sy PF, _
':0S31003001:003S320814SBun
021S2
66-30/531
365
Date
$
Dollars
e.ox.