52005D - Reeves

. LAMA/ U DREDGE & FILL
GENERAL PERMIT Previous permit#
Clew ❑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 I5A NCAC 4, ) 1 0O
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Rules attached.
t Name �5 - �t/_i ..cL✓I✓ c, Project Location: County QE,.>J1 (L.
ss 2\ \ t� W v\-c ,J,Ce ,3 t-., iye..,t1-r S Q,. Street Address/State Road/
/Lot#(s)
t>nv --PSI E.AI) State&L ZIP qq3 L.�T \-Z. 0/4-4-j2 nXs c,t--i A c.41
#(`1\c)t{l- - 1-St-6 Fax#( ) Subdivision L z )(7 3-tp. ; 1'S1. rr&'-/
�ized Agent C,,irE r•-,f_...�"C S City- r rtiAr )Q A� z4 e ZIP
d ❑CW ❑EW ❑PTA .ES ❑PTS Phone# ( ) River BasinL A
❑OEA ElHHF ❑IH J❑UBA ❑N/A
l: Adj.Wtr. Body. Ps.c t_ t,-.-;!**) Z.-`-ar"'42\(nat
E PWS: III FC:
yes / no PNA /wo Crit.Hab. yes / no Closest Maj.Wtr. Body 1�T'1‘/"\/
of Project/Activity 11 N S`-i-. 'k\'-‘' ' V I:0 1 L- Cz--..v.L.-v._
(Scale: 1"
lock)length
rm(s)
pier(s) _ 1
length
i I
lumber j
gad/Riprap length 1\ 1 ti i
wg distance offshore
nax distance offshore �� .
channel
:ubic yards —
amp
)use/Boatlift
Bulldozing �' �, t
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Ine Length I j 1 4
1 - ! 1
yes no i A ,
igs: not sure yesCo)r f
i 11' l
C
)rium: n/a yes .
yes (nn. C '
•Attached: yes j
ling permit may be required by: ?E•tJ1->g(L—_ (---ibV,.4"('1 See note on back regarding River Basin

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Letter of agent
I —SAC ,J• % U 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.
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• 16 - y 3 1 `3'-I C1 date
Contact information

+ - __ _ -_ __ __ _ .. _vi...+iii•
ADJACENT RIPARIAN PROPERTY OWNER NO 1"1FICATION/WAIVER FORM
Name of Individual Applying For Permit: 7W/f o ro ir/ )4,!
Address of Property:4p f /a- �/,fdin, jot/ _a
(Lot or Street#, Street or Road)
AlefroAhfe(
(City/and County)
I hereby certify that I own property adjacent to the-above-referenced_property_ The indiv
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 letth
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 object
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 mi
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.
Z-'grnme Date
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