50356D - Mossman

ECAMA / ❑DREDGE & FILL
GENERAL PERMIT Previous permit#
New ❑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 15A NCAC
Rules attached.
ntN, 1ame i 4*-- f1(�. 5 A MJ Project Location: County re�/j'
s �'r
1 V - S *_O • Street Address/State Road/Lot#(s)
•r ASYk6 State N L ZIP Z- .'S ` (-41171-C
#()2-10,5153 Fax#( ) Subdivision i'UOS-/t7(J'7D pJ f i r S
ized Agent I ie}1Q K ( L.�M S.1TS City l (S T E?O ZIP Z ELI MIL'
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d ❑CW €SEW or PTA ❑ES El PTS Phone# ( ) River Basin
❑OEA ❑HHF ❑IH El UBA El N/A Adj.Wtr. Body j Y1 (LL 0,--e -72_. nat
////
El PWS: ❑FC: �
Al GOV)
yes /. o PNA yes 0 Crit.Hab. yes / no Closest Maj.Wtr. Body
Af Project/Activity I NS I --C, t;Cr L. r / I (Scale: (rr¢-
lock)length _ r
m(s)
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pier(s) �����=�� ���M�� ���rE� •
length HINEMIIIIIIIIIIIIIIIIIIIIMMIIIIIMEMMIIIISMISIM
camber IIlIHNIHhIHhIIlHhIIIiiIAhIIIiii
:ad/Riprap length
vg distance offshore ...��..� �� ���7,1,,,. �.
nax distance offshore ��2 M:M�M���� M EA M■
channel HhIIH5!IHhIIHHN !UIHH
■•■■•C�■ua e al ■■ I ■■ �1i�■
ubic yards 111111111; ' / z 71i /Ijamp MIPPIEVA.....x.lip..m
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ine Length �Y / IE!!1!!!�' rnlII
: Fy
not sure es 6.
ags: not sure yes
orium: n/a yesS
1 I
I 1 LL
III
r Attached: yes no — '
ding permit may be required by: fl See note on back regarding River Basin
n n .„,.-.-,. ..I c A r -mil/J !7ui,l I _ . ..a.. C-rram, iis_'1.'7 L<']/ I

Letter of agent
I ShvarT Mc sn1c 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.
cT(J -7- /_ . moss
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�.w,�►.ae '»2D1r,ti.2,_cI10 date 3/i 1°9
Contact information s. Gies.
lee4e Cher) L 7i.?,� (N)
T ID x !T 24 / (c)

ADJACENT RD AR1AN PROPERTY owPizR STATEMENT
I hereby oat*that t owe property 54)Ecera to ,5rtuar`�" / avf)'a r e
tNa.e of Property Ow•a•)
property located at 4/1 'r�'S 'C'iata, — ---
I (lad BNods.T ale-)
on 1 Yi t0Mt --.,^a l�R�1 �[y -- N C.
( At•T odr) (Tow.*ail&Gaut')
He her.Mere to au as showy baker',lbe devcfopmat he is ptopoaia4 at that)oortioi,
and„l have no objeclioM to hie propowL
DESCRIPTION ANTWOR DRAWING OP PROPOSED DEVBL.OP111 1
(1'i bar r Qr biglrithasi proposing attwitraa■g)
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4- I .4 / • f.....
t � _' '
• „, IC. ,'; 2 v 1,42>
'Pa0'�
Pleolb
fill',t441,1C,
-'- 9 —
(Appleest lalrtraaiee) (Rive a properly Owner)n6rnratlo.

ADJACENT RIPARIAN PROPERTY OWNLK STAIL/VIEll I
I hereby certify that I own property adjacent to 51 o I"1 O (a n 's
(Nave of Property Owner)
property located at IA A P..S ?oca
p (Lot,Block,Roan etc-)
on c1 JL G g ,m niilie _ �7(F1CY� ,N.0
d/6 .
(Waterbody) (Tow*aor 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 OP PROPOSED DEVELOPMENT
(To be filled is by individi alpnaposing 1P 't)
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4
71-
ti �►ef8Kf3
Ntod5211A4
(Applicant Information) (Riparian Property Ow►aer Information)
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Mailing
Ctry/Stal &C" /5 Prig or roe Nafffe
?ie ��Q 9aa7aTeitome Number Itstephono Nrwber
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CLEMENTS MARINE CONSTRUCTION INC
112 CIRCLE DRIVE 910-270-9110 1556
HAMPSTEAD,NC 28443
531
Date'. / 9—c�'9 66 30/365
Pay
totoe �d'�C`'171r I $ZQp r
4Zl< / /,,,.. y�4 J Dollars 8 L ,l
0 First Citizens
rrstc Bank fu ens.com
PQ
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For ig6 � ‘71/'
n J
1:0 5 3 100 3001:0035320814580 01556 G'P`jOMIol %)
COASTAL VIEWS®