52006D - Brandon

E CAMA/ ❑DREDGE & FILL ,_
pENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue IA Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources t�
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -1 r"1 , I ��
$t` ules attached.
t Name 'L; a,:;�,-�t- Project Location: County : tips L
ss L\ `- Street Address/State Road/Lot#(s)
State: ZIP �_:-� '' y LDI- Li> WQc1-.\Z-1J(z i,D IN..)#('--', '. ") . ,, , i ) Fax#( ) Subdivision Lo p
t l Cs \Q.-1 N\ t51 r\1 E 5
rized Agent v `j City \--\'ArrQS�(t,X- ZIP Z.$14
d E CW ❑EW 0 PTA ES ❑PTS Phone# ( ) River Basin(n (>t
rLi OEA ❑HHF ❑IH ❑UBA ❑N/A i--- [-AL, NAI 7
): ❑ PwS: ❑FC: `
Adj.Wtr. Body ) PSpct�. �v.,.a7/ (nat
yes r no PNA ye no Crit.Hab. yes / no Closest Maj.Wtr. Body Ca Z W
of Project/Activity L )f \ut... C." I o Y '�N ! L. i��L. a L..p.D
1 (Scale: 1`'-
;dock)length
I . I
)rm(s)
j
:r pier(s) ;
1length I I i
number
lead/istanc length i
'
avg distance offshore L
max distance offshore
I j
,channel
.. 1i
cubic yards I f
ramp I
louse/Boatlift I V
Y.* II to/
i Bulldozing 4 _
P ` .
line Length j I I
not sure.> yes no I I t }�
ags: not sure yes Eta?— ' E r L ! f
:orium: n/a yes r ni5'. II t
s: yes i rip'"_ 1I
:r Attached: yes eg• I
ding permit may be required by: \ E-N-NE(L- ( .-C I See note on back regarding River Basin
s/Special Cnnditinnc c<k-% w i....r G. \ .�, . .2 .r I i ...-e-4 1 ( \ _

TRUCTION INC 1091
Date Z9—(v� 30/3
365
$ atOr
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z Dollars 8 a ,
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AV
120.8 LI, 580 O L09Pig L
` COASTAL VIEWS*
•

• __ .� v�..x•ai l 1
ADJACENT RIPARIAN PROPERTY OWNER NO f1l-ICATION/WAIVER FORM
Name of Individual Applying For Permit: JAri105 )re, )J071
Address of Property: Le, P Z WC�Shif�j ) a•oze /ZJ-
(Lot or Street#, Street or Road)
/7Gr�► �i �edr cite r
(Cit3i and County)
I hereby certify that I own property adjacent to the above-refeienced_property. The indivi(
applying for this permit has described to me as shown on the attached drawing the development 1
are proposing. A description or drawing,with dimensions, should be provided with this latex
I.have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
set bck a minimum distance of 15' from my area of riparian access-unless waived by me,
you wish to waive the setback,you must initial the.appropriate blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
a-2 7-oo
S' Nam /r—re Date
ter- I // _ , l AWA

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Letter of agent
I _JA on E'S T3 Z J Do n/ 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.
J i1-v &J
Prim-a e ,
Signature
date
Contact information