51378D - Worthington

•
l'CAMA/ ❑DREDGE & FILL
4 ENERAL PERMIT Previous permit#
New ❑Modification ElComplete 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 ISA NCAC 1 N 42 c
�ZRules attached.
t Name r V\ICK ' +$?r.yiTh Project Location: County V\I LThil
s°ir' 7 '_/,'/ r: `',t ,,,, Street Address/State Road/Lot#(s)
State ZIP . ( G L,L-0 L" 1.: i c -3 IC')
•( ) Fax#( ) Subdivision Di-IX 190 11\i _
;ed Agent W,t -VC.K. C L. t\4 i.2-. ' City (kfi'\ ,1 L ZIP 7 k-i
❑CW P,EW F3IITA ❑ES ❑PTS Phone# ( ) River Basin( f
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body( J4 AL CIF- rDeStVIL Ci t- t
❑ PWS: ❑FC:
yes C/ PNA yes /j Crit.Hab. yes / no Closest Maj.Wtr. Body L�
Project/Activity tZ 1 v Pr'E Ogc
(Scale:
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ier(s)
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ngth
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d/Riprap length I
distance offshore
ix distance offshore l
cannel
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401
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ng permit may be required by: I I See note on back regarding River Basin ri
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CLEMENTS MARINE CONSTRUCTION INC 1363
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD,NC 28443 (�/�'�Q` 66-30/53i
Date l Q 365
Pali or h / -/'/_2*ViZ I $ )
1 74 /Z � le( C..1 Dollars 6
First Citizens 4
Bar
ens.c
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Fe
' 63�Q hale
I: i . II 001:0035 8080, 58ii' 0L363
COASTAL VIEWS°°
•
QC

.�i vu vv rV d O UU.I U ROI I V V lJJ LI 111 I N
.L uo I I : Jia mark Clements 910-270-9110 p_ 1
Letter of agent
� I
I G`�' /,J O/'.T7-I,4_ i ti 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.
Prim n e
Sign-a" re ) _
--- 6 date 7j / ; /c,.y
Contact information , ?

DIVISION OF COA51 AL MANAutiviciv I
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORIV
Name of Individual Applying For Permit: 0 100 o4 1 1) I+00
Address of Property: i "32- ,O)c) 6 )Y) g-ci
(Lot or Street#, Street or Road)
tiaMe5)eCAC)
(Cit)/ and County)
. :,y certify that I own property adjacent to the-above-referenced.psoperty_ The inc
appl forthis pennithas describedto me as shown on the attached drawing the developmi
are , . , ,0-1,g. A ' ' "" :on or drawing,with dimensions, should be provided with this l
,a`,
r I"have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of 1
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-3!
within 10 days of receipt of this notice. No response is considered the same as no obj4
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift
set bck a li 1 imum distance of 15'from my area of riparian access-unless waived by
you t a waive the setback, you must initial the.appropriate blank below.)
5`'' �� / I do wish to waive the 15' setback requirement.
i
I do not wish to waive the 15' setback requirement
/ -)
/ r _
•
Sign ame • ate
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Pt i/ 1).,A- -.),-frz--- ic) Arar,
Print Name ..:••••�•• ••..•�

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DIVISION OF COAS I AL MANAlst1V1t1N t
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORIV
Name of Individual Applying For Permit: ()►v ©c�`11) 171
� _
Address of Property: 1 `�2- (7)Cl 1 )Y)* £�
(Lot or Street#, Street or Road)
e4C4) � -
(Cit/ and County)
I hereby certify that I own property adjacent to the:above-refelenced_property. The inc
applying for this permit has described to me as shown on the attached drawing the develop=
are proposing. A description or drawing,with dimensions, should be provided with this 14
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of 4
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-35
within 10 days of receipt of this notice. No response is considered the same as no obj€
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat Iift
set bck a minimum distance of 15' from my area of riparian access-unless waived by
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
aID
Print Name . . �. RI

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Si at re
item 4 if Restricted Delivery is desired. Agent
• Print your name and address on the reverse x ❑Addressee
so that we can return the card to you. B. Rec ived b Printe Name) C. Date f livery
• Attach this card to the back of the mailpiece,
or on the front if space permits. ��/ D�(J�
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
? c,bert zac-K.
�a5
bBr5011 /V 3. Service Type
I 1)�O ❑Certified Mail ❑Express Mail
❑ Registered ❑Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7005 0390 0003 3402 8705
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540