54082D - Holt

CAMA/ LI DREDGE & FILL r 1
IENERAL PERMIT Previous permit#
New ,liodificai on ❑Complete Reissue ❑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 I 5A NCAC~---) , f - ) Z'
` Rules attached.
:Name �t,}._\..J�J t,C) L Project Location: County ?a*... 0 6 tL
L 1 o L_ -c 1.6 2 051;3 rJ 9--a Street Address/State Road/Lot#(s)
.AR-C- Cori-\) StatelJG ZIP Za-I 4S _},t
( ) Fax# ( ) Subdivision
Bd Agent C.r,.r..re-` t.5\'S CitySv,q..F [.----'f T�1 ZIP 2.11=',1-"\f-
0 CW EW C]8TA L ES PTS Phone# ell )(a - c1 C.--- S River Basinl ?G f
❑OEA ❑HHF ❑IH ❑UBA N/A Adj.Wtr. Body GllIp$A�-L %•,•. U'a ns In
❑ PWS: [LIFO:
yes no PNA cD/ no Crit.Hab. yes k no
Closest Maj.Wtr. Body `�j�+'�._ �--1.�c'
Project/Activity "rt-)S-T:A t-L, 12",c ) Z L - t rr t=X.ESTI.„/G PL
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distance offshore ■■■■ lii :II 111
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not sure yes no U■■■R■��� linik.
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s: not sure yes INE �I�
ium: n/a yes no
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yes no IINIIMMINI
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kttached: yes MINIM_�- I '
ng permit may be required by: .S L^ ve S T 1 n See note on back regarding River Basin rt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)I hereby certify that I own property adjacent to (✓�� (on ►10 � 1L
's
(Name of Property Owner)
property located at 41 0 L, A-A e., rt 1,0 i' -
(Lot,Block,Road,etc.)
\
onC InJ ,in e n de l_ ,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. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet(15') from my area of riparian access unless
waived by me.
V I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
7 ?roplede j'A c-
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Y n Print or Type Name

I' ,
Consent for Use of General Permit 7H.1200
Lot Number/Address: y 10 LIT-r LE kaa5iz ) 9--c-
County: PE.v.) E 4L Subdivision:
Criteria:
(check all that apply)
Primary Nursery Area.
x Less than 2.0ft deep.
❑ Greater than 2.0ft but less than 3.0ft.
❑ Submerged Aquatic Vegetation.
❑ Bottom habitat.
Comments:
K 02-6. recoA rn s ( ys 64 ) g" +n r k iwyttch •(I
p rn I- at.,S o kf, r►, Ff DS STOPS tr j '
Decision:
❑ Issue General Permit
❑ Elevate 'or 134 ' ,r
/fr
0/9'-' 9- o ,
NC Division of M. '►- - sheries Representative Date
\, k n siO / IAD1
N ©- AL) r,S.4 la-,.,,

7 Iv.JVQ ldyuv k.,vvycI a Vuy J IJVJL(V
09 09: 38a mark Clements
919-832 - r163
Letter of agent
( l
1have retained Mark Clements DBA, Clements
Marine
Construction Inc,to+4- Homake 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.
DPI lor\
—Sipa
9 l(ll� �/�� date ii
Con ; information

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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete is)ign re df- 'P� /,P /
item 4 if Restricted Delivery is desired. '/r� �7 • Agen
• Print your name and address on'the reverse (., Y,, f /:4
so that we can return the card to you. Addressee
• Attach this card to the back of the mailpiece, B. Recery (Printed Name) gate f D 'very
or on the front if space permits. ",��� c7
1. Article Addressed to: D. Is delivery address ' nt from 1? Yes
If YES,enter del' :, 0 No
cP
p " 75 2 /6 c 3 cv
6_ 7)
ee�e( civra7 /e� �� qf
/�/"]/Q �1 �y� 3. Service Type N\ l)c�Y�'
( rr// 'K /J' 27 7 q ❑Certified Mail Express Mail
G `/V C.+ L / 0 Registered 0 Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7007 1490 0001 8396 412 8
i PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. X 0 Agent
• Print your name and address on the reverse 0 Addressee
so that we can return the card toyou.
h B. Receiv y(Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece, DYGd '• r, i. U 1
or on the front if space permits. D.
5
D. Is delivery address different from item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
// 11AA,251
4/ /er-17'"S
7 vo t // --
/77Ø//sAJ N C 3. Service Type
Certified Mail ❑Express Mail
Zg36 ) 0 Registered 0 Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7007 1490 0001 8396 4135