50296D - Harris

LiCAMA/ ❑DREDGE & FILL
[çENERAL PERMIT Previous permit#
ew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized by the State of North Carolina,Department of Environment and Natural Resources -�
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 N `1--' --'
'Rules attached.
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ding permit may be required by: 1 p t �1 e Q.. lr wr-cy I See note on back regarding River Basin
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CLEMENTS MARINE CONSTRUCTION INC 1243
112 CIRCLE DRIVE 910-270-9110
I1AMPSTEAD,NC 28443 Date 6_ /7 1 66-30/531
Pay to the 11/e,6k,7/ i $ p,
Order of
4 � Dollars 8 , L.:•
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First Citizens
Bank
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For-43 5 —Ge5bA.'IG ,x, • ..__
I:0 5 3 L00 30 01:0 0 3 5 3 208 L 4 58ii' 0 L 2 4 3
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COASTAL VIEWS°

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ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: h A v to R. NA A.R'S
Address of Property: ''t"5 At. k ft/4 e-it- t a
(Lot or Street#, Street or Road)
14A M / f cer 4 7 j Ar c 2 $ '# 3 '
(Cit)I and County)
I hereby certify that I own property adjacent to the.above referenc e&pioperty. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this lette
I.have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co:
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-:
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu:
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.
Sign Name Date
AVA
a:_.i.T... - - -

Letter of agent
I A v ,o 4. N R ,Q►S 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.
OAv to R. /-I,RRIc
Print name
I- . R. �J .�,►.,.�,
Signature
9/G - 32. 9- 2651 date /"1Al 3 20a
Contact information

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: v o , , f/el RRi S
Address of Property: 'tS W. K i P/S14 c . Ad L
(Lot or Street#, Street or Road)
NA �►+ Ks i o .�L 2 tt 41.3
(City and County)
I hereby certify that I own property adjacent to the.above-referenced_propelty. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this lettc
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co.
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu
set bck a minimum distance of 15' from my area of riparian access-unless waived by ml
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.
Sign Name J Date'
A A