54408D - Tyer

CAMA/ DREDGE & FILL .°�
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 5A NCAC )k\ \ LA)
Rules attached.
t Name 3Vh.rr.2 \/ L R_,- Project Location: County ems* .1-)t--a--
`
' > �'-\\-,',`\-\ ,:. Street Address/State Road/Lot#(s)
.0-. 5-c v . State 1J - ZIP -`3L1 L ) ‘-"\"1 i-\'=5 ''V
(1 '0) 2-;3' I1lc Fax# ( ) Subdivision
zed Agent t t-mow` a S 1,.\'1 . _-_ „_, `t' City )C I\Pr' P5''L�AS) ZIP Z-8.1-1
_CW li EW ❑;PTA DES ❑PTS Phone# ( ) River Basin Li i
OEA HHF 0 IH ❑UBA ❑N/A Adj.Wtr. Body AJ(-+) CA-61 'I— t
_ PWS: ❑FC:
Closest Maj.Wtr. Body yes / no . PNA yes / no Crit.Hab. yes / no
Il )1--LA- L 2 6 t_
f Project/Activity ._ : c"L-
(Scale:
ock)length `•.
m(s) — '
pier(s)• `�
— -- —
length
lumber + 44 so. IL - -
sad/ 'prap length
— _._..—
lug distance offshore I�..�v -----1 I
nax distance offshore �. _ ----� i
I -
channel I --.
-t- 1 --- -- --
:ubic yards
amp - --
)use/Boatlift
a 1
_ P L _ 1� I
Bulldozing i I
I f
ine Length li ! 1 —
not sure yes
igs: not sure yes (gyp)
>rium: n/a yes I ' ._ — ,
• yes I
i
Attached: yes
lingby: t- --R.0 7)t �-.D r.- o•t
permit may be required `� I
/ See note on back regarding River Basin i
C..eci.l Cnnditinne

3ajc) Ln SCC* ►q 7z13
Letter of agent --
I U c S ) have retained Mark Clements DBA, Clements
Marine Construction Ide, 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.
..- A,m•es f- I
Print e
Signature
g - ///. date
Contact information

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Mdfa MOMS EtWAV amen awe Wes' Wirat,C - MIN MOO fifaMti OMMIS „.MUM._,. MOW'..
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CLEMENTS MARINE CONSTRUCTION INC cJ 1845
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD,NC 28443 "*' 66-30/531
//] //�_0 365
(� l Date
Pa to the t��C. 0cl/l� I $ arc)
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First Citizens �'�,�� �l
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1:053 L003001.00353 208 l45811' 0 L845
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COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
)lete items 1,2,and 3.Also complete A. Signature
4 if Restricted Delivery is desired. � ❑Agent
your name and address on the reverse X f(y�"
-iat we can return the card to you. ❑Addressee
,ch this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of -
deron the front if space permits.
cle Addressed to: D. Is delivery address different from item 1? Eles
If YES,enter delivery address below: ❑ No
I 102:2 I,
.6 n ;4(4_03 3. Se�rv.ce Type
Certified Mail ❑ Express Mail
0 Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑ Yes
Article Number
Transfer from service labe. 7007 1490 0001 8396 4197
Form 3811,February 2004 Domestic Return Receipt
102595-02-M-1540
a
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signatyr
item 4 if Restricted Delivery is desired. /�y II Agent
• Print your name and address on the reverse X l 1yt a Addressee
so that we can return the card to you. B. Received by(P n d Name) C. Data of Delivery
• Attach this card to the back of the mailpiece, /�69--
or on the front if space permits. D. Is delivery address different from item 1? Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
O'1,25 . i4c, ern LvGct' .
601 du* ceN.d
J--)U rn p ad-d- 3. Service Type
(�((4-3 Certified Mail El Express Mail
2 (/ 7 ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7007 1490 0001 8396 4180
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540